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

项目摘要/摘要 这项研究的广泛、长期的目标是解决黑人妇女和 分娩的人，最明显的表现是严重的孕产妇发病率和孕产妇死亡率。在那里的时候 多个人口在孕产妇健康结果方面的差异，黑人社区尤其 受不良生育结局的影响。黑人人口的孕产妇发病率和死亡率为2-4。 是非西班牙裔白人人口的三倍。这些差距在一些国家甚至更大 像纽约市这样的社区，在那里，非西班牙裔黑人女性的怀孕相关死亡率 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-- 在非西班牙裔黑人女性中，这一比例是非西班牙裔白人女性的2.5倍。在……里面 除了有较高的医疗和产科合并症、死亡率、早产和婴儿 死亡、黑人妇女和分娩的人可能会经历产科种族主义，表现为 在怀孕、分娩期间寻求护理时的轻视、不尊重、丧失自主性和虐待 出生。已经确定了预防孕产妇死亡和严重孕产妇发病率的机会 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 在所有这些层面上都需要为怀孕和分娩创造系统健康和令人振奋的条件 在黑人妇女和生育人群中。然而，许多上游干预措施将需要相当长的时间来 产生影响。解决现在可以改变的因素是当务之急。我们建议，重要的进展可以 通过利用现有围产期护士队伍的专业知识来处理信息， 黑人妇女和寻求传统方式分娩的人的协调、转诊和护理经验需求 产前和以医院为基础的产妇保健。这项研究将评估黑色的可行性和可接受性- 妇女主导的围产期护士导航计划，旨在解决孕产妇健康结果方面的差异， 减少产科种族主义的经历，通过以黑人的需求为中心改善母亲的福祉 在纽约市从事传统产前护理和医院分娩的妇女和分娩人员。这个 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) 收集和检查关于计划结果的描述性数据，以便为未来的有效性测试提供信息；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。 这项综合性支持性护理模式的形成性干预研究将为未来奠定基础 药效测试。如果成功，围产期护士导航计划有可能减少可预防的 严重的孕产妇发病率和死亡率。这样的程序还具有快速伸缩性的潜力 利用现有的劳动力，并适应多个背景和文化群体。

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.