1. Section Editor(s): Adams, Ellise D. PhD, CNM
  2. Perinatal Guest Editor
  3. Gregory, Katherine E. PhD, RN
  4. Neonatal Editor

Article Content

Perinatal nursing is hard work. Whether assisting a woman to give birth, caring for a newborn, or assisting the postpartum woman to recover from childbirth, there are many issues related to the birth environment that may become barriers to this work. In this issue of The Journal of Perinatal & Neonatal Nursing, 31:1, titled "Care Environment and the Workplace," each article discusses these issues and explores barriers experienced by the perinatal nurse as well as identifies solutions to these barriers.


Dr Samantha Sommerness and her colleagues contributed a quality improvement project in their article, titled "The Perinatal Birth Environment: Communication Strategies and Processes for Adherence to a Standardized Guideline in Women Undergoing Second-Stage Labor With Epidural Anesthesia." This article provides suggestions for transitioning from an approach to second stage that is directive to one that encompasses the principles of laboring down. The guidelines used in this project are published for use by our readers.


In "Consequences of Delayed, Unfinished, or Missed Nursing Care During Labor and Birth," Drs Kathleen Rice Simpson and Audrey Lyndon present findings from 11 focus groups in 6 hospitals. In this study, the authors explore nursing care that is missed or delayed from the perspective of perinatal nurses. They also identify potential maternal and newborn outcomes associated with this missed or delayed care. Understanding the findings of this study will help better define the role of the perinatal nurse and inform development of nurse-sensitive performance measures and ultimately improve patient outcomes.


The numerous workplace challenges faced by the perinatal nurse are framed by both personal beliefs related to birth and the influence of the type of birth environment. In "Workplace Challenges: The Impact of Personal Beliefs and the Birth Environment," by this guest editor, Dr Ellise Adams, personal beliefs and the birth environment were explored through the use of focus groups and a concept analysis. By identifying personal beliefs and aspects of the birth environment that promote or prevent workplace challenges, specific birth practices and interventions can be modified or developed to overcome workplace challenges.


Finally, in the special editorial that I coauthored with Cristen Pascucci, founder of Birth Monopoly, the serious issue of workplace aggression is discussed. In this editorial, a recent exemplar is used to frame obstetric violence. Obstetric violence can occur not only as healthcare worker to patient but also as healthcare worker to healthcare worker and patient to healthcare worker. By identifying and understanding acts of bullying, incivility, violence, and aggression, effective and sensitive patient care can be promoted within the birth environment and a collegial, supportive workplace is possible for the perinatal nurse.


This issue of The Journal of Perinatal & Neonatal Nursing (JPNN) is focused on the Care Environment. We have included 4 in-print publications on this topic, which were submitted from 4 different countries around the world. Seeing that this topic is important to authors from the United Kingdom, Canada, Italy, and Sweden underscores how important the care environment is to the outcomes of infants, their families, and the clinical teams who care for them. We also have multiple online publications dedicated to this topic. Please be sure to check the JPNN homepage for these and other publications.


Inga Warren's contribution from the United Kingdom focuses on the notion that the quality of care that infants and families receive during their time in the neonatal intensive care unit (NICU) will be significantly influenced by the well-being of the people who care for them. Furthermore, she emphasizes that we often underrecognize the emotional work of caring for these patients, which can negatively influence clinical outcomes. Enhancing the clinical environment through establishing a healthy work environment, educational enrichment, and opportunities for reflection can help overcome stress, burnout, and compassion fatigue, resulting in positive outcomes for both clinicians and patients. Marsha Campbell-Yao and colleagues from Canada report on their research findings, which quantified sound levels in neonatal and pediatric hospital settings. They found that sound levels exceeded recommended standards almost all of the time, and this was most commonly associated with talking. They report that "staff and families realize that high sound levels can be a problem but feel that the culture and context are not supportive of a quiet care space." Their research findings will contribute to future interventions aimed at enhancing the environment of care via efforts focused on reducing sound levels.


Bembich and colleagues from Italy report on the effects of nursing-induced stress on short-term outcomes in preterm infants. They specifically focused on weighing and bathing of the preterm infant and found that stress responses in the autonomic and motor systems were observed in infants at all postmenstrual ages. However, they also found that while preterm infants were stressed by weighing and bathing, if they were supported by interventions such as swaddling and nesting following these procedures, they recovered autonomic and motor stability within 5 minutes of the procedures. Van den Berg and colleagues from Sweden have shown that to optimize family-centered care and the well-being of staff working in the NICU environment, the physical care environment should be designed to meet the needs of the infants, their families, and staff. They emphasize that it is important to evaluate the effects of a purpose-built neonatal unit on staff perceptions of job strain and the psychosocial climate. Their research shows that during the initial transition to a new space, job strain increases. However, they also showed that this job strain and overall satisfaction with the work environment improve over time with positive outcomes for staff and family-centered care.


This issue of JPNN welcomes 2 new additions to our columns. We are delighted to have a new Neonatal Expert columnist, Joan Renaud Smith, PhD, RN. Joan is a neonatal nurse practitioner at St Louis Children's Hospital in St Louis, Missouri. She has a long history of experience and expertise in neonatal nursing, and we are extremely fortunate to have her leading the Neonatal Expert column. We are also introducing a new column focused on pharmacological principals and practice in newborn care. This column is written by Sara Rostas, PharmD, a neonatal clinical pharmacist at Brigham and Women's Hospital, Boston, Massachusetts. We hope that you will find this column helpful in staying current with the state of the science in pharmacological care of the newborn. Finally, Terese Verklan has contributed Parting Thoughts.


In closing, I would like to acknowledge Rosanne Harrigan, EdD, MS, APRN-Rx, FAAN. Dr Harrigan was a long-standing member of the Neonatal Editorial Board who passed away on October 16, 2016. She had most recently served as the Chair of the Department of Complementary and Integrative Medicine at the University of Hawai'i (UH) School of Medicine. She was the former Dean of the UH School of Nursing and Dental Hygiene. Dr Harrigan made numerous contributions to pediatric nursing and maternal child health and was named Nurse of the Year by the American Nursing Association. She was also named National Nurse of the Year by the March of Dimes and, in 1985, was named to the prestigious New York Academy of Sciences. We thank Dr Harrigan for her service to JPNN and for her countless contributions to our profession.


Best regards,


-Ellise D. Adams, PhD, CNM


Perinatal Guest Editor


-Katherine E. Gregory, PhD, RN


Neonatal Editor