Advanced nursing practice Evidence based lit review Subject: African American women, pregnancy/childbirth mortality
QUESTION
Write out your PICOT/PICOTS question using the following format or your DeNisco text and/or Melnyk & Fineout-Overholt text.
P=Patient Population of Interest
What populations are you interested in?
I=Intervention/Issue
What intervention are you interested in?
C=Comparison Intervention
What will the intervention be compared to?
O=Outcomes
What outcome do you want to see?
T=Time
What timeframe or duration?
S=Setting (if applicable)
What is the setting of care?
Literature Review
Review the PICOT/PICOTS and search databases for appropriate research articles from peer-reviewed sources. Strive to find higher levels of evidence (e.g., randomized controlled trials (RCTs) or guidelines; however, all peer-reviewed evidence is acceptable). A minimum of five articles to be included.
Find data to support the significance of the problem or concern. Why is it a concern? Discuss the significance of the problem, based on your findings and using citations.
Create a synthesis table of the evidence in the articles you found, using the template from the DeNisco or Melnyk texts, and embed it into the paper.
Write a synthesis of the literature review (synthesize and narrate your findings into the paper) in 1–2 pages.
Provide an overall summary and review the rubric prior to submission.
Ensure that your paper submission includes correct grammar, spelling, punctuation, citations, APA format, no plagiarism, paraphrasing, limited quotes, appropriate headings, and clarity. Be sure to review your rubrics for these assignments.
Advanced nursing practice Evidence based lit review Subject: African American women, pregnancy/childbirth mortality
Rubric
NURS 5351 Evidence Based Practice Introduction Paper Rubric (Fall 2021)
NURS 5351 Evidence Based Practice Introduction Paper Rubric (Fall 2021)
Criteria Ratings Pts
This criterion is linked to a Learning OutcomePICOT Question
30 pts
Accomplished/Excellent
All aspects of PICOT are addressed and realistic and demonstrate importance or clinical relevance, and health-care delivery impact is well-defined.
27 pts
Competent/Satisfactory
All aspects of PICOT are addressed and mostly demonstrate importance or clinical relevance, and health-care delivery impact is discussed.
20 pts
Needs Improvement/Unsatisfactory
Most aspects of PICOT are present; some discussion of clinical relevance is present.
0 pts
Deficient
Aspects of PICOT are missing or poorly written, or clinical relevance is missing or vague.
30 pts
This criterion is linked to a Learning OutcomeLiterature Synthesis Table
30 pts
Accomplished/Excellent
Synthesis table of the literature is organized and well-developed. More than five peer-reviewed articles are included.
27 pts
Competent/Satisfactory
Synthesis table of the literature is organized. A minimum of five peer-reviewed articles are included.
20 pts
Needs Improvement/Unsatisfactory
Synthesis table of the literature is present; organization may need improvement. Only 3–4 peer-reviewed articles are included.
0 pts
Deficient
Synthesis table of the literature is poorly organized or missing completely. Fewer than three peer-reviewed articles are included.
30 pts
This criterion is linked to a Learning OutcomeLiterature Synthesis
30 pts
Accomplished/Excellent
Synthesis of the literature demonstrates understanding of concepts, issues, and solutions that have been researched. More than the minimum of five peer-reviewed articles are included.
27 pts
Competent/Satisfactory
Summary of the literature mostly demonstrates understanding of concept, issues, and solutions. A minimum of five peer-reviewed articles are included.
20 pts
Needs Improvement/Unsatisfactory
Summary of the literature is vague or does not demonstrate relation of concepts, issues, and solutions to each other (no synthesis), or only 3–4 peer-reviewed articles are included.
0 pts
Deficient
Literature review is poor or vague, or two or fewer peer-reviewed articles are present.
30 pts
This criterion is linked to a Learning OutcomeProfessional Writing, Grammar, Format
10 pts
Accomplished/Excellent
Correct grammar, spelling, and punctuation without errors. No errors in citations or APA format, no plagiarism, limited quotes. Has appropriate headings; clarity is present.
9 pts
Competent/Satisfactory
Mostly correct grammar, spelling, and punctuation with minimal/few errors. Minimal errors in citations or APA format, no plagiarism, limited quotes. Has appropriate headings and clarity mostly present.
5 pts
Needs Improvement/Unsatisfactory
Grammar, spelling, or punctuation with multiple errors. APA or citations have multiple errors or many quotes. No plagiarism. Some headings present.
0 pts
Deficient
If plagiarism is detected or the honor code is violated, the paper will earn a zero. Grammar, spelling, or punctuation is very poor, with multiple errors. APA or citations are very poor or missing. No organization.
10
Advanced nursing practice Evidence based lit review Subject: African American women, pregnancy/childbirth mortality
ANSWER
Nursing Practice Evidence-Based Lit Review
Subject: African American Women, Pregnancy/Childbirth Mortality
Student’s Name
Institutional Affiliation
Course Name and Number
Instructor’s Name
Date
Advanced Nursing Practice Evidence-Based Lit Review
Subject: African American Women, Pregnancy/Childbirth Mortality
Introduction of the Healthcare Problem and Its Significance
People are entitled to safe and high-quality healthcare services regardless of their racial, ethnic, cultural and socioeconomic backgrounds. Various social determinants also significantly influence the populations’ ability to access the various healthcare services, thus impacting their health outcomes and quality of life. Some of the social determinants of health that influence the power of the population to access health services include; income level, educational opportunities, occupation, employment status, workplace safety, gender inequity and racial segregation. These social determinants increase the prevalence of certain health conditions to particular groups and impact some states more on the vulnerable population. The Centers for Disease Control and Prevention (CDC) indicate that racial and ethnic disparities have contributed significantly to pregnancy and childbirth mortality. According to the report, Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die due to pregnancy-related causes than white women (Ai-ris & Molina, 2019).
Similar reports indicate that the pregnancy-related mortality ratio (PRMR) is four to five times higher for black and AI/AN women than the white women, with a significant difference observed even in states with the lowest PRMRs. Pregnancy and childbirth mortality are preventable. However, the prevalence is highly likely to increase if the various health disparities are not addressed (Petersen et al., 2019). Multiple stakeholders, most notably the healthcare providers, should apply evidence-based practice regarding the ethical standards of practice to ensure unbiased, safe and high-quality care to the population to address this healthcare issue.
PICOT Statement
Addressing this healthcare concern requires a multidisciplinary approach, where various stakeholders collaborate to develop effective interventions that adequately address the issue. Multiple interventions have been created to help address this issue, but limited success (Howell et al., 2018). This calls for the need to develop other interventions and compare which intervention will effectively prevent these deaths. The PICOT framework is applicable in such a scenario. Together with evidence from peer-reviewed and credible articles, various stakeholders can determine the best approach which will help in preventing such mortalities and improve patient health outcomes and quality of life. Therefore, regarding this healthcare issue, the PICOT question would be: In African American women (P), does identification and addressing of implicit bias in healthcare (I) compared to not addressing such discrimination at all (C) help in the prevention of pregnancy or childbirth mortality (O) within a period of 18months (T)?
Synthesis Table of the Evidence in the Articles
Being a global concern, researchers have looked into the issue, intending to determine a solution that will help address it. Readers should ensure that the articles which outline this issue are credible and reliable to ensure that the information obtained helps address the issue. Various researches have been done concerning the effectiveness of various interventions in addressing this issue. However, this discussion focuses on articles that describe how the identification and handling of implicit bias in healthcare effectively prevent pregnancy or childbirth mortality among African American women. The discussion includes five articles, which are summarized in a synthesis table as follows.
Table 1: Synthesis Table of the Evidence in the Articles
Citation Purpose Design and
Strength /Level of Evidence Sample participants volunteers Measurement(s) is used in the study or report
Results/ Conclusions/ Recommendations
Vedam, S., Stoll, K., Taiwo, T. K., Rubashkin, N., Cheyney, M., Strauss, N., & Declercq, E. (2019). The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health, 16(1), 1-18. The purpose of the study was to determine various dimensions that contribute to mistreatment in childbirth in the US. Online cross-sectional survey (Level II) The study involved 2700 eligible participants, of which 2138 completed all sections of the survey. The surveys were distributed online, with various patient designed items included. The prevalence of mistreatment was then quantified, depending on the indicators. One in every six women reported having experienced one or more mistreatment. Rates of mistreatment were higher among women of colour and having a male partner who is black. Other factors such as vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years were associated with decreased rates of discrimination. The findings indicated that mistreatment is mainly experienced by women of colour, hospital births, and among those with social, economic and health challenges. Exacerbating factors include unexpected birth complications and disagreements between the patients and the providers.
Jain, J. A., Temming, L. A., D’Alton, M. E., Gyamfi-Bannerman, C., Tuuli, M., Louis, J. M., & Riley, L. E. (2018). SMFM Special Report: Putting the “M” back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action. American journal of obstetrics and gynaecology, 218(2), B9-B17. The purpose of the study was to develop recommendations that will help reduce racial and ethnic disparities in maternal morbidity and mortality in the US. The article mainly consists of findings obtained from a workshop convened in 2016 in Atlanta. N/A N/A Racial and ethnic disparities significantly contribute to maternal morbidity and mortality. Effective recommendations and immediate actions are crucial to address this issue.
Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Syverson, C., Seed, K., & Barfield, W. (2019). Racial/ethnic disparities in pregnancy-related deaths—the United States, 2007–2016. Morbidity and Mortality Weekly Report, 68(35), 762. The article’s purpose was to address the racial and ethnic disparities contributing to pregnancy-related deaths in the US. cross-sectional analysis (Level II) NA The pregnancy-related mortality ratios (PRMRs) were determined over the period and analyzed with demographic characteristics. Pregnant mothers who are black are likely to receive poor quality healthcare services, which translate to the development of complications, increased morbidity and mortality among these women. There is a need to address the various health disparities to reduce the associated morbidity and mortalities.
Howell, E. A., Brown, H., Brumley, J., Bryant, A. S., Caughey, A. B., Cornell, A. M., … & Grobman, W. A. (2018). Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(3), 275-289. The purpose of this article was to reduce the various peripartum disparities by advocating for equity in the delivery of healthcare services. The article is designed to provide insight into healthcare providers and systems on how the various disparities impact maternal outcomes. NA NA Black women are three to four times likely to die from pregnancy and birth-related complications. This indicates the role of ethnic and racial disparities in the development of these complications. Measures should be put in place to address the various disparities to ensure equity in the delivery of healthcare services.
Ai-ris, Y. C., & Molina, R. L. (2019). Maternal mortality in the United States: updates on trends, causes, and solutions. No reviews, 20(10), e561-e574. The purpose of this article was to highlight the various interventions which help address maternal morbidity and mortality in the US. NA NA NA In addressing maternal morbidity and mortality, it is crucial to determine the various factors which predispose one to a high likelihood of getting affected. One of these is addressing racial disparities, which significantly contribute to maternal morbidity and mortality.
Synthesis of the Literature Review
The articles used to support the intervention and show its effectiveness were selected based on their satisfaction levels of the various criteria used to determine credible and reliable sources. Most resources were from the PubMed database, which is reliable. The most striking feature of all the articles is that they outline how mortality deaths are rising in the United States, with various factors contributing to its increase. The most outstanding factor that has been associated with increased mortalities is the multiple health disparities and social determinants of health, with the article highlighting that most mortalities occur among African American women compared to their white female counterparts. This strong racial association led the researchers to develop studies that identified why this association exists and how they can improve it. Vedam et al. (2020) revealed various forms of mistreatment at health facilities, with most cases being reported towards women of colour compared to white females. This indicates that discrimination at the health facilities significantly contributes to developing maternal complications among women of colour; this should be addressed appropriately.
The article by Jain et al. (2018) indicates that African American women are the most affected; therefore, the need to develop immediate actions that will effectively remove the various health disparities that contribute to maternal morbidity and mortality. Petersen et al. (2019) indicate that the low-quality care which African American women receive is the major contributing factor to the increased maternal morbidity and mortality in this group, thus the need to improve the quality of care which they obtain by removing the various health disparities that render this group more vulnerable.
Additionally, Howell et al. (2018) suggest a framework that will help in addressing this issue, which mainly focuses on enlightening the healthcare providers and the healthcare system on the influence of the various disparities on maternal health outcomes and the best ways to address these disparities to improve their health outcomes and reduce these mortalities. Lastly, in their article, Ai-ris & Molina (2019) identified the various factors contributing to the increased prevalence of maternal mortalities in the general population. Then, they provided the various critical interventions that could help address this issue and highlighted structural racism and the social determinants of health as a significant intervention in preventing pregnancy and childbirth mortalities among African American women.
Conclusion
In summary, maternal deaths are a primary global concern. Various organizations have developed interventions to help in addressing this concern. The prevalence of this issue among African American women in the US prompts the need to develop interventions to address the factors contributing to the increased prevalence of such mortalities in this group. The articles support the intervention developed in the PICOT framework. They support the effectiveness of identifying and addressing implicit bias in healthcare due to racial differences in preventing pregnancy and childbirth mortalities among African American women. Therefore, the intervention should be incorporated in various strategies used to these mortalities.
References
Ai-ris, Y. C., & Molina, R. L. (2019). Maternal mortality in the United States: updates on trends, causes, and solutions. No reviews, 20(10), e561-e574. https://neoreviews.aappublications.org/content/20/10/e561.abstract
Howell, E. A., Brown, H., Brumley, J., Bryant, A. S., Caughey, A. B., Cornell, A. M., … & Grobman, W. A. (2018). Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(3), 275-289. https://www.sciencedirect.com/science/article/pii/S0884217518300649
Jain, J. A., Temming, L. A., D’Alton, M. E., Gyamfi-Bannerman, C., Tuuli, M., Louis, J. M., … & Riley, L. E. (2018). SMFM Special Report: Putting the “M” back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action. American journal of obstetrics and gynaecology, 218(2), B9-B17. https://www.sciencedirect.com/science/article/pii/S0002937817323748
Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Syverson, C., Seed, K., … & Barfield, W. (2019). Racial/ethnic disparities in pregnancy-related deaths—the United States, 2007–2016. Morbidity and Mortality Weekly Report, 68(35), 762. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6730892/
Vedam, S., Stoll, K., Taiwo, T. K., Rubashkin, N., Cheyney, M., Strauss, N., … & Declercq, E. (2019). The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health, 16(1), 1-18. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0729-2?fbclid=IwAR3xIiEXnMpA2IboUbFcL0GIoliz9Q-V-bREvkCdwMCf4iozKIxqiLWK0d4