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What The Stork Brought: Endogenous Fertility Preferences
Get PDFWhere most existing literature on fertility preferences has described how fertility preferences shape outcomes, this paper provides insight into how the sex of a recent birth affects a mother’s fertility preferences. Utilizing data from the Demographic Health Survey from 1985-2020 in 81 countries containing 309,238 mothers who gave birth in the past 12 months and who have equal to or fewer than three children, I employ OLS with two-way fixed effects as my primary specification, examining the effects of the plausibly exogenous sex of a recent birth on sibship sex composition preferences. Results show that a recent daughter birth increases a mother’s stated ideal number of daughters by roughly 0.1 while decreasing the ideal number of sons by about 0.06. Additionally, a recent daughter birth raises the ideal number of total children by 0.04, but this result is less robust to endogeneity. Previous literature has emphasized the power of the firstborn child in shaping a mother’s preferences, but this paper displays that mothers continuously update their preferences past the first birth in magnitudes statistically analogous to treatment effects of the first birth. Treatment effects of a recent daughter birth are directionally homogeneous across different model specifications and when testing for heterogeneous treatment effects across a variety of distinct subsamples. Convincingly, results can be explained within the framework of cognitive dissonance theory, ex-post rationalization, and contact theory. Considering the persistence and directional homogeneity of the results, a novel psychological regularity emerges: mothers with a recent daughter birth prefer a greater ideal number of daughters and a lower ideal number of sons when compared to those who recently birthed a son
Standardizing Nurse Knowledge Exchange in the Peripartum Mesosystem
Get PDFProblem Handoff report is a significant source of medical error, as reported by the Joint Commission. As it stands, Hospital A’s peripartum mesosystem has no standardized policy regarding the Nurse Knowledge Exchange (NKE) process. Context Hospital A is an urban tertiary care medical center in San Francisco, with its peripartum mesosystem divided into two floors with a total of 35 dedicated beds. Intervention Stakeholder engagement, literature review, and mesosystem analysis identified potential barriers to bedside NKE. To address the identified causes, the project implemented a standardized handoff guide and staff education. Measures The outcome measured was comprehensiveness of NKE as evaluated by a binary coding system. Results NKE comprehensiveness improved significantly when utilizing the bedside handoff guide with an increase from 33.5% at baseline to 77%. Comprehensiveness of NKE regardless of location rose from 74% to 91%. Conclusion The intervention was found to successfully improve NKE comprehensiveness. To ensure ongoing success of this change, continuous leadership support and further PDSA cycles must be pursued
Unlocking the Potential of Peripartum Handoff: Standardizing Nurse Knowledge Exchange (NKE)
Get PDFProblem The absence of a structured and standardized handoff during patient transfers may result in the unintentional omission of patient information, medical errors and adverse events. No standardized bedside handoff process, referred to as Nurse Knowledge Exchange (NKE), was observed in Hospital A’s peripartum mesosystem during patient transfers from the Labor and Delivery (L&D) unit to the Postpartum unit. Context Hospital A is a medium-sized urban hospital located in Northern California. The peripartum mesosystem includes 21 postpartum rooms and nine laboring rooms. Intervention Through the recruitment of stakeholder engagement, review of literature supporting evidence-based practices, and a mesosystem assessment, a standardized handoff guide was developed and piloted. This standardized handoff guide aimed to improve communication between nurses and patients as well as promote patient-centered care. Pilot champions were educated on the use and importance of the guide, and then observed utilizing the guide during patient transfers. Measure The comprehensiveness of the NKE was measured using a binary coding system. Results The pilot study indicated a notable improvement in the comprehensiveness of the NKE when the standardized handoff guide was used. The percentage of bedside NKE improved from 33.5% to 77% and the overall comprehensiveness of NKE regardless of location improved from 74% to 91%. Conclusion The standardized handoff guide significantly enhanced the comprehensiveness of the bedside NKE. The involvement of key stakeholders in promoting such a change proved essential for the success of the pilot project and the sustainability of the suggested change going forward
Transforming Peripartum Nurse Knowledge Exchange (NKE) through a Standardized Handoff Guide
Get PDFProblem: Medical errors and adverse events can result from inconsistent handoffs during patient transfers. As seen in Hospital A’s peripartum unit, there is no formal policy regarding the handoff process, also known as the Nurse Knowledge Exchange (NKE). This quality improvement project aims to introduce a standardized handoff guide to enhance communication and minimize harmful outcomes following patient transfers.
Context: The setting for this project is an urban hospital in Northern California with nine laboring beds and 21 postpartum beds.
Interventions: The project employed a systemic approach involving stakeholder involvement, literature review, and data analysis to identify areas for improvement in the handoff process. Standardized handoff manuals and protocols were created and piloted based on the assessment. Offering training and education to the staff ensured consistent and efficient utilization of the updated handoff procedures.
Measures: The project’s outcome measure is the comprehensiveness of NKE, which is evaluated by a numerical grading tool.
Results: The utilization of the bedside handoff guide led to a remarkable enhancement in the comprehensiveness of handoffs. The occurrence of NKE at the bedside increased from 33.5% to 77%, while the overall comprehensiveness of NKE increased from 74% to 91%.
Conclusions: The successful implementation of standardized handoff protocols within the peripartum mesosystem demonstrates the efficacy of best practices in enhancing patient safety and care quality during transfers. It is crucial to maintain these improvements by constantly monitoring and evaluating the protocols
Enhancing Nurse Awareness of a Stroke Patient Satisfaction Survey and their Significance in Practice
Get PDFProblem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. InterventionTo address this gap in care, an educational presentation using literature evidence in support of SSPS was presented to nursing staff during the monthly department meeting. Measures The aim of this presentation was to ensure 100% of nurses in the NOU acknowledge SSPS importance by April 18, 2024 to maintain safe, quality care for stroke patients and meet regulatory standards. Successful change in practice was evaluated through a questionnaire administered before and after the education module. It gauged nursing staff attitudes toward SSPS and their likelihood of encouraging patient participation on a Likert scale from 1 to 5. Results The QI team found average pre-intervention scores of 4.4 and 3.6 for significance and likeliness to encourage, respectively, and post-intervention Likert scores of 4.1 and 3.6, respectively. Optional comments from nurses implied confusion about their role in SSPS implementation. Conclusions These results suggest that Hospital X NOU nursing staff are open to implementing a SSPS, but require clarification on their role
Evaluating the Client Base and Housing Outcomes of a Community Based Organization Serving Unhoused Adults
Get PDFThere is a well-documented, bidirectional relationship between mental health and housing instability. When coupled with the complex historical, societal, and political factors contributing to houselessness, the result is a unique set of mental health needs within this community. Despite this, there is a low rate of mental health service utilization and a dearth of research on how to tailor services to meet the needs of unhoused individuals. Additionally, first-hand perspectives are often omitted, as this population is seen as “hard to reach”. The goal of this two-phase mixed-methods program evaluation was to better understand the demographic and mental health profiles of unhoused clients seeking mental health treatment through a community-based organization in the South Bay Area, to identify areas in which services could be adapted to meet the needs of the client base. Additionally, clients receiving mental health services were interviewed, to ensure recommendations provided were based in consumer experience. The first phase of the study was a secondary data analysis of electronic health record data that revealed that female identifying and those living with others endorsed significantly more adverse childhood experiences. The second phase included 6 semi-structured interviews analyzed through thematic analysis, from which 6 themes emerged: (1) “journey” to LifeMoves, (2) seamless connections, (3) importance of trust, (4) dynamic needs of the unhoused, (5) benefits of therapy at LifeMoves, and (6) areas of growth. These findings highlight the need for a reconceptualization of trauma and mental health symptoms within the unhoused community and the importance of including first-hand perspectives in research
Education for Primary Care Providers on Advance Care Planning
Get PDFBackground: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.
Problem: At a primary care clinic in Midtown Sacramento, CA, there was little emphasis on ACP in the primary care setting. Consequently, the clinic’s providers had insufficient knowledge of ACP and limited confidence in discussing EOL care plans with patients.
Intervention: This Doctor of Nursing Practice (DNP) project provided a 30-minute educational session for clinic providers on ACP. The presentation was conducted with PowerPoint on a live Teams video meeting. The presentation defined ACP, described its importance in primary care, discussed common barriers to its implementation, and offered the providers tools to enhance their ACP practices.
Measures: Using pre- and post-intervention surveys, the project explored the effects of the educational session on provider-reported knowledge of ACP, confidence in having these EOL conversations, and the likelihood of practice change around this aspect of patient care.
Results: Twenty-one clinic providers attended the educational presentation on ACP. The audience consisted of nurse practitioners, physician assistants, and physicians. Twelve providers participated in the pre-intervention survey and eleven participated in the post-intervention survey. Survey results indicated an increase in provider knowledge and confidence around facilitating ACP in the primary care setting and most providers reported being likely to change their ACP practices after the educational session.
Conclusion: Healthcare providers require continuing education on ACP to adequately discuss EOL planning and care alternatives with patients. By obtaining more knowledge on ACP, providers can increase their confidence in integrating ACP into practice, ultimately benefitting patients’ care and quality of life
The Potential of Southeast Florida’s Coral Reef Tract to Enhance Climate Resilience of Ecosystems and Communities
Get PDFIncreasing anthropogenic greenhouse gas emissions have led to more heat being trapped in the atmosphere, raising our overall global temperature. The hottest recorded sea surface temperatures in Southeast Florida occurred in 2023 causing extreme coral bleaching and high mortality in part of the Florida Reef Tract (FRT). Coral reefs play a vital role in protecting coastal communities from storm surge and sea level rise, reducing wave energy by up to 97% across whole reefs. However, with increasing ocean acidity and thermal stress from climate change, coral ecosystems are struggling to maintain their structural complexity and overall health, much less provide substantial protection to human communities. Through a literature synthesis, environmental assessment, environmental justice analysis, and an analysis of risk management strategies, I assess the FRT’s potential to reduce flood risk from storm surge and sea level rise. This paper examines how the FRT can enhance climate resilience for both marine ecosystems and communities in Southeast Florida amidst climate change. My analyses find that coral reefs have significant wave attenuation potential only if structural complexity and carbonate accretion are high. I also find that coral reefs can reduce climate injustices in disadvantaged communities by reducing flooding from rising seas and greater storm surge. However, policies are needed to avoid climate gentrification in protected neighborhoods. I conclude that the five biggest impacts and threats to the FRT are climate change, loss of coral biodiversity, coral disease, pollution, and direct human activities such as dredging and fish trapping. Swift climate action and stringent policy are necessary to protect and sustain the benefits provided by the FRT. This includes quickly reducing greenhouse gas emissions to net zero, increasing restoration efforts, updating local sewage infrastructure to reduce pollution runoff, and implementing legislation that further promotes the protection of coral reefs
EVALUATING CLIMATE MIGRATION THROUGH DISCOURSE ANALYSIS OF INTERNATIONAL POLICY FRAMEWORK AND “EL PROGRESO” COMMUNITY BLOG
Get PDFABSTRACT
Environmental changes are driven by global warming, such as rising temperatures, melting ice, and increased natural disasters which directly affect the living conditions of huma thereby driving migration. This study highlights the inadequacies of current migration management policies as the United States is seeing a significant influx of migrants from Central America. The focus of this discourse analysis is on the role of inadequate policies and the failure of international efforts like the Paris Climate Agreement in addressing the issue of climate-induced migration effectively. Despite the goals set by such international agreements to mitigate the effects of climate change and limit global warming, the El Progreso Blog post exposes the effect of climate change and how it causes forced displacement with thousands displaced annually from Honduras. Qualitative analysis was used to evaluate the effectiveness of the Paris Climate Agreement and other related policies in managing climate migration with the lens of the Environmental Migration Theory and the Political Ecology Theory. Focusing on Honduras, the research scrutinizes the impact of these international policies on Central American migration patterns, assessing their success and shortcomings. The findings underscore the glaring omission of Climate migrants and migration in the Paris Agreement, and this speaks to the non-recognition of climate migrants as refugees. It is therefore important to have comprehensive policy reform to better manage climate-induced migration. Conclusively, the study adds to the much needed academic discourse on climate migration, providing detailed insights into policy failures and recommending improvements. It aims to foster international cooperation among policymakers and stakeholders involved in migration management and robust policy frameworks to tackle the increasing challenges of climate-induced migration effectively
HELP SEEKING EXPERIENCES OF ASIAN AMERICAN PARENTS OF CHILDREN WITH AUTISM SPECTRUM DISORDER
Get PDFAutism Spectrum Disorder (ASD) has become more widely understood and accepted by the general and professional populations. However, self and social stigma related to ASD persist and continue to negatively impact help-seeking behaviors. This qualitative study used semi-structured interviews guided by an ecological systems model, to explore the lived experiences of 11 Asian American (AsAm) parents residing in the greater San Francisco Bay Area with a child with ASD. A thematic analysis framework was utilized. A total of six themes and six subthemes emerged from this study and included: (1) comparisons, (2) stigma, (3) resilience, (4) support for services, (5) needs for AsAm parents and their children, and (6) advice to other AsAm parents. One subtheme of cultural perceptions was generated for comparisons. The remaining five subthemes of denial, fear, language, isolation, and hopelessness were generated under stigma. Cultural perceptions of child development and behavior contributed to AsAm parents’ understanding of atypical development and ASD, particularly when making comparisons of their child within their microsystem and exosystem. Social stigma endorsed in the microsystem and exosystem was often attributed to behaviors viewed as disdain within the AsAm community, increasing endorsement of self-stigma amongst AsAm parents for raising a child with ASD; thus, impacting help-seeking behaviors. A positive support system amongst nuclear family members, extended kinship, and support professionals mitigated the negative consequences of stigma and contributed to participants\u27 engagement in help-seeking behaviors. Implications for this study include guidance for professionals in providing culturally responsive services to this hard-to-reach population