Frontier Nursing University

Inadequate postpartum care coordination may contribute to preventable maternal morbidity and mortality and misses a crucial opportunity to engage patients in their care after giving birth. More than half of pregnancy-related deaths occur between one week and one year postpartum, and health disparities are consistently observed for marginalized populations. The optimization of providing postpartum care must prioritize a person-centered approach and support the transition back to primary care in order to improve maternal health outcomes. A rapid-cycle quality improvement initiative was implemented over 8 weeks in a federally qualified health center serving a population with predominantly low risk medical needs. At baseline, only 53% of clinic patients attended a postpartum visit within 3 weeks of birth, and none had a care plan in place to facilitate the transition back into primary care. This initiative aimed to improve the patient experience of fourth trimester care planning and engagement to a mean score of 5 (from a baseline of 4.3 on a 6-point scale) on the modified 9-item Shared Decision Making Questionnaire (SDM-Q-9) in 8 weeks. Care coordination using a pregnancy care passport and a fourth trimester registry were implemented to support patient-centered engagement, evidence-based care, and to track outcomes related to care coordination progress. Engagement in postpartum care planning as a shared decision-making experience improved to a mean score of 5.8 on the SDM-Q-9 in eight weeks. The registry demonstrated a statistically significant improvement in fourth trimester visit scheduling and attendance (P <.05), with the largest gains noted in the use of lactation services. This initiative employed patient-centered postpartum care planning and coordination to improve patient satisfaction, engagement, and access to health care services in the postpartum period, using tools that can be adapted for other settings. Future projects should explore the use of these interventions in higher-risk populations.

WKS 4: Addressing Racism in Health Education: A Toolkit for Action, B203 (FCSH), September 3, 2025, 14:30 - 15:30Racism is intimately intertwined with the history of medicine, nursing, and health education,1 impacting all learners but particularly harming students of color.2 Reducing racism-related harm that health sciences students experience during their education is an upstream tool to reduce health inequities and prevent student attrition.3 Health professions faculty can improve the quality of curricula for all students by applying antiracist tools to their courses, textbooks and programs.4A group of midwifery educators and clinicians from the United States developed a toolkit designed to reduce racism in midwifery curricula, with broad applicability to other health professions. The toolkit includes a validated self-assessment tool, course and curriculum assessment checklists, and tools for the evaluation of racism in health professions textbooks and materials. The toolkit is available at no charge through the American College of Nurse-Midwives, which initiated the project, at https://midwife.org/wp-content/uploads/2024/09/addressing_racism_and_advancing_equity_in_midwifery_education-a_program_content_toolkit_for_action.pdf. The toolkit can be utilized independently by individuals or by faculty groups. It has also been presented in a workshop format, allowing participants to interact with the developers and experience hands-on utilization, including support in using the tools in participants’ own syllabi and curriculum.

As the field of nursing moves toward competency-based education, faculty need to adapt teaching and learning strategies to meet standards for assessing core behaviors of graduate psychiatric mental health nurse practitioner students. This article reviews a psychotherapy skills-based learning assignment at Frontier Nursing University that was adapted to meet developing competency-based learning standards. The assignment utilizes prerecorded video scenarios to provide students with opportunities to reinforce psychotherapy skills during didactic coursework. Assessment is conducted via an analytic rubric and specific feedback is given to each student in writing.

Expansion and diversification of the midwifery workforce is a federal strategy to address the maternal health crisis in the United States. Understanding characteristics of the current midwifery workforce is essential to creating approaches to its development. Certified nurse-midwives and certified midwives (CNMs/CMs) certified by the American Midwifery Certification Board (AMCB) constitute the largest portion of the US midwifery workforce. This article aims to describe the current midwifery workforce based on data collected from all AMCB-certified midwives at the time of certification. Midwife initial certificants and recertificants were administered an electronic survey about personal and practice characteristics at the time of certification by AMCB between 2016 and 2020 for administrative purposes. Given the standard 5-year certification cycle, every midwife certified during this period completed the survey once. The AMCB Research Committee conducted a secondary data analysis of deidentified data to describe the CNM/CM workforce. In 2020 there were 12,997 CNMs/CMs in the United States. The workforce was largely White and female with an average age of 49. There has been a slow increase (15% to 21%) of initial certificants identifying as midwives of color. The proportion of CMs to all AMCB-certified midwives remained less than 2%. Physician-owned practices were the most common employer. Approximately 60% of midwives attend births, and hospitals were the most common birth setting. Over 10% of those certified to practice reported not working within the discipline of midwifery. Targeted recruitment and retention of midwives must take into consideration not just expansion but dispersion, scope of practice, and diversification. The proportion of midwives attending births was lower than reported in previous years. Expansion of the CM credential and accessible educational pathways are 2 potential solutions to workforce growth. Developing strategies to retain those who are trained but not practicing presents an opportunity for workforce maintenance.

Abstract IntroductionNaloxone use has increased in recent years in response to the nation’s opioid crisis. Once only available to health care professionals, it is now obtainable by prescription for persons at risk for substance overdose and their families. Increasing its availability is seen by some as an “over-the-counter solution” to the opioid problem. However, while naloxone has been viewed as relatively safe, with a low side effect profile when appropriately dosed and monitored, it is not without safety concerns that may go unrecognized or misattributed to other causes.MethodsHere we present a case study of a 41-year-old female who presented to our medication-assisted treatment (MAT) clinic complaining of sudden onset weight gain, shortness of breath, upper and lower extremity peripheral edema, tachycardia, insomnia, and nocturnal enuresis. These symptoms made it difficult for her to work at her housekeeping job, resulting in missed workdays. She had seen a primary care provider for her symptoms and been prescribed a rescue inhaler for her shortness of breath. This patient had previously been treated for opioid use disorder with buprenorphine/naloxone and experienced similar symptoms, which disappeared when she relapsed on opioids. However, symptoms reappeared upon resuming her prescribed treatment.ResultsThe patient was identified as experiencing side effects to naloxone, causing noncardiogenic edema. Her MAT medication was switched to buprenorphine. Within two weeks her heart rate had returned to normal, she had lost weight, and she no longer had nocturnal enuresis or needed the rescue inhaler. Her peripheral edema resolved so she was able to walk better and resume work. At the same time, buprenorphine continued to relieve her cravings.There is a dearth of information related to naloxone-induced edema. Our patient had not received a formal evaluation of pulmonary edema, but her pulmonary and cardiac symptoms were consistent with that diagnosis. Although pulmonary edema is mentioned in the product literature, peripheral edema is not. A literature search indicates that the number of case studies on naloxone-induced pulmonary edema have increased since 2018, but only one other case of naloxone-induced peripheral edema was discovered.Conclusions/ImportanceNaloxone is used in a variety of settings by differing types of health care providers. As the number of persons treated with naloxone increases, there will likely be a corresponding increase in incidences of pulmonary and/or peripheral edema as side effects. Providers and patients who are not aware of these manifestations and their relationship to naloxone treatment may easily attribute presenting symptoms to cardiogenic or other causes, as this case illustrates. It is important for providers in all settings to consider new onset shortness of breath and edema within the context of the person’s whole health and to be aware of their implications for mental as well as physical health.FundingNo Funding

The 2022 Supreme Court decision leaving the regulation of abortion to the states is sure to result in a complex regulatory environment for patients and nurses. In states where abortion is illegal, patients may self-manage abortions using medications they obtain through the mail or by other means. Nurses may care for these patients in multiple settings and may wonder about their own legal and ethical obligations. This article reviews patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights. Recommendations for ethical patient care are also provided.

Decisions made at all levels affect health outcomes. Decision-making theory explains how these decisions are made. Cultural values provide the framework. Grounded in the moral foundations, the history, and the traditions of a nation, cultural values drive decisions. Maternal health outcomes in the United States reflect decisions based upon core American cultural values operating from the individual, family, and community level to the implementation of national policy.