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

项目总结/摘要 这项研究的广泛，长期目标是解决黑人妇女生育结果的不平等问题， 产妇死亡率和孕产妇发病率都很高，这最明显地表现在产妇发病率和孕产妇死亡率很高。虽然 在孕产妇健康结果的差异为多个人口，黑人社区，特别是 受不良出生结果的影响。黑人产妇发病率和死亡率为2-4 比非西班牙裔白色人口高出一倍。在某些国家，这种差距甚至更大。 社区，如纽约市，非西班牙裔黑人妇女的妊娠相关死亡率 仍然比非西班牙裔白色妇女高8倍。同样，严重的孕产妇发病率发生在2- 2.5非西班牙裔黑人女性的发病率是非西班牙裔白色女性的两倍。在 除了具有更高的内科和产科合并症、死亡率、早产和婴儿死亡率之外， 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 轻蔑，不尊重，失去自主权，虐待，而寻求照顾期间怀孕，分娩， 出生已确定了预防孕产妇死亡和孕产妇严重发病的机会， 多层次，包括通过临床医生，卫生设施，系统和社区。干预措施 需要在所有这些层面为怀孕和分娩创造系统性的健康和令人振奋的条件 在黑人妇女和分娩的人中。然而，许多上游干预措施将需要相当长的时间， 产生影响。解决现在可以改变的因素是紧迫的。我们建议，重要的进展可以 通过利用目前围产期护士队伍的专业知识来处理信息， 协调，转介和护理经验的需要，为黑人妇女和分娩的人寻求传统的 产前和住院产妇护理。本研究将评估一个黑- 妇女主导的围产期护士导航方案，旨在解决孕产妇健康结果的差异， 减少产科种族主义的经历，并通过集中黑人的需求来改善产妇福祉 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。的 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） 收集和检查项目结果的描述性数据，为未来的疗效测试提供信息，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引导导航计划的响应。 这种支持性护理综合模式的形成性干预研究将为未来的研究奠定基础。 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 产妇发病率和死亡率很高。这样的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.