IU Indianapolis ScholarWorks :: Browsing by Author "Stiffler, Deborah"

Browsing by Author "Stiffler, Deborah"

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Addressing Disparity: What Aspects of African American Culture Contribute to an Increased Risk for Sudden Unexpected Infant Death (SUID)?
(Office of the Vice Chancellor for Research, 2015-04-17) Ayres, Brook; Fauvergue, Cheyenne; Cullen, Deborah; Stiffler, Deborah
Introduction: African American infants in the United States were 2.4 times more likely to die in the first year of life than white infants. In Indiana, the 2013 overall Infant Mortality Rate was 7.2, but the rate for African Americans was 15.3. Non-breast feeding mothers, sleep positioning, sleep surface, bed sharing, and learning barriers among African American mothers suggest differences in outcomes as compared with infants born in white families. This systematic review of the literature focuses on the corollary variables between SUID and African American culture, specifically what puts African American babies at an increased risk for dying. Methods: A rigorous multi-database search was conducted using key words SUID, African American Culture. Originally we accessed 217 articles. Of these 217 articles, we found fifteen qualitative articles and 28 quantitative articles that met our inclusion criteria of being between the years 1990-2015 and had a specific link between African American culture and SUID. We will be using the System for the Unified Management, Assessment and Review of Information (SUMARI) through the Joanna Briggs Institute. Two tools, the Qualitative Assessment and Review Instrument (QARI) and Meta-Analysis of Statistics Assessment Review Instruments (MASTARI) will carry out the validity, reliability and data extraction. Results: Preliminary themes suggest that breast-feeding, sleep positioning, and sleep surface, bed sharing, and learning barriers may contribute to the SUID disparity among African Americans. Conclusion: Further investigation may prove useful in determining what interventions could be placed in practice to decrease SUID in black infants. Health care professionals need to be aware of the disparity when developing their approach to care for African American infants and their families.
Considerations in Safe to Sleep® Messaging: Learning from African American Mothers
(2019) Stiffler, Deborah; Matemachani, Sherry; Crane, Lisa
Purpose: The purpose of this study was to identify why African American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African American mothers might be more likely to follow these recommendations. Design: We recruited African American mothers with infants over the age of 6 months to participate in two focus groups facilitated by a Community Engagement Manager experienced in focus group facilitation. We used ethnography in order to find shared patterns of behavior and beliefs in African American women related to safe sleep. Results: We identified 14 concepts and formulated them into three categories: It’s Just Easier; Can’t Fight Culture and Grandma; and Effectively Teaching Mother. From these we were able to identify the shared value of Multifaceted Learning. Practice Implications: African American Mothers say that they are generally aware of the Safe to Sleep® recommendations, even though the majority of mothers do not follow them. The reasons they give for not following them are that they are not comfortable doing so, they feel they are unable to do so, or find it unnecessary. Many of the mothers attempted to follow the Safe to Sleep® recommendations, but abandoned the effort due to the stress of their crying infant. Trying to follow the Safe to Sleep® recommendations were stressful for the mothers, even though there was concern expressed by some that their infant could indeed suffocate or die from SIDS. The mothers gave suggestions on how they would change the message or the delivery of the message.
Considerations in Safe to Sleep® Messaging: Learning from African American Mothers
(Wiley, 2020-01) Stiffler, Deborah; Mukasa Matemachani, Sherry; Crane, Lisa; School of Nursing
Purpose: The purpose of this study was to identify why African-American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African-American mothers might be more likely to follow these recommendations. Design: We recruited African-American mothers with infants over the age of 6 months to participate in two focus groups facilitated by a community engagement manager experienced in focus group facilitation. We used ethnography to find shared patterns of behavior and beliefs in African-American women related to safe sleep. Results: We identified 14 concepts and formulated them into three categories: it's just easier; can't fight culture and grandma; and Effectively teaching mother. From these we were able to identify the shared value of multifaceted learning. Practice implications: African-American mothers say that they are generally aware of the Safe to Sleep® recommendations, even though the majority of mothers do not follow them. The reasons they give for not following them are that they are not comfortable doing so, they feel they are unable to do so, or find it unnecessary. Many of the mothers attempted to follow the Safe to Sleep® recommendations but abandoned the effort due to the stress of their crying infant. Trying to follow the Safe to Sleep® recommendations were stressful for the mothers, even though there was concern expressed by some that their infant could indeed suffocate or die from sudden infant death syndrome. The mothers gave suggestions on how they would change the message or the delivery of the message.
Development of the theory of shared communication : the process of communication between parents of hospitalized technology dependent children and their nurses
(2014) Giambra, Barbara Klug; Broome, Marion; Buelow, Janice; Stiffler, Deborah; Sabourin, Teresa Chandler
Technology dependent children such as those who require a feeding tube, tracheotomy or ventilator are a special group of chronically ill children who require complex care on a daily basis. When these children are hospitalized, the accompanying parent and the nurse caring for the child on the inpatient unit must communicate together about the care of the child. Care for the technology dependent child is optimized when parents and nurses both understand the plan of care for the child. To discover the process of parent-nurse communication that results in mutual understanding of the child’s plan of care, a grounded theory study to explore the perspectives of the parents of previously hospitalized technology dependent children was undertaken. The Theory of Shared Communication emerged from the data and illuminates the parent-nurse communication process. The antecedents of the process are respect for own and others expertise. The communication process consists of six communication behaviors; ask, listen, explain, advocate, verify understanding and negotiate roles. The behaviors are nested within each other and all are not necessarily required for the non-linear process to result in the relational outcome of mutual understanding of the child’s plan of care. An integrative review of the literature regarding the process of communication between parents of hospitalized chronically ill children and their nurses shed light on the components of the process, but no study was found that explicated the entire communication process. A subsequent grounded theory study added the perspectives of the nurses to the original theory. No new components of the process were uncovered, but the nurse’s narratives added significantly to our understanding of the communication process. Additionally, parents of currently hospitalized technology dependent children confirmed the propositions of the Theory of Shared Communication.
Globally, What Affects Primary Caregivers’ Grieving Processes Leading To Subsequent Effective And Ineffective Coping Strategies Following An Infant Mortality.
(Office of the Vice Chancellor for Research, 2015-04-17) Birch, Nicole R.; Campbell, Hailey N.; Cullen, Deborah; Stiffler, Deborah
Worldwide in 2013, 4.6 million infant deaths occurred within the first year of life and accounted for 74% of all deaths under the age of 5 years old. As a result of these infant death events, there are varied zcaregiver grief responses and coping strategies. The purpose of this study was to meta-synthesize what factors affect primary caregiver grieving processes and then analyze their effective and ineffective coping strategies. After a rigorous multi-database search, we accessed 9 articles worldwide from years 1995-2013 for inclusion. These 9 papers were assessed for credibility by a primary and secondary reviewer via standardized critical appraisal instruments from the Joanna Briggs Institute. Data extraction and metaaggregation of the findings was carried out to determine intergenerational coping strategies and grieving process after an infant death. Eight peer reviewed articles were included in the aggregation. The data extracted included specific details about intergenerational support, interrelationship support, and lasting emotional impressions following an infant death. We identified that the influence of living children and parents of the primary caregivers are significant sources of intergenerational support. Conversely there is a lack of support between primary caregivers leading to incomplete coping and grieving processes within the relationship. Furthermore, lasting emotional impressions were acknowledged as a recurrent theme among individuals affected by the loss of an infant. Nursing interventions and education should be identified that address caregiver and family member grieving processes and coping strategies such as follow up emotional coping assessments at regular intervals for those at risk for poor coping. Nurses have the ability to play a vital role in improving the family and caregiver outcomes including positive coping strategies and healthy grieving processes following infant mortality.
How an Interprofessional Team Develops and Implements a Grassroots Maternal-Child Health Leadership Program to Address Infant mortality
(2019-10) Stiffler, Deborah; Evans, Kelly; Hale-Tahirou, Latoya; Loper, Ilene; Moore, Vera; Phillips, Ashley; Levine, Naomi; Anderson, Heather; Turman, Jack
Background: It is time to complement the work of our health care providers with a concerted statewide, community-centered approach to build infrastructures and systems that address social-economic-environmental factors that contribute to poor birth outcomes. The complexity of system issues that contribute to poor birth outcomes requires an interprofessional team, comprised of community and academic partners to develop feasible, affordable and implementable solution strategies. Hypothesis: Community capacity building improves MCH-related social-political factors of communities with poor birth outcomes.
The Mother's Lived Experience of Breastfeeding in the First 4 Weeks Postpartum: A Heideggerian Hermeneutic Phenomenological Analysis
(2021-04) Rosales, Stacy Ann; Stiffler, Deborah; Bute, Jennifer J.; Shieh, Carol; Wallace, Linda S.
The benefits of breastfeeding are widely known and documented, yet breastfeeding rates at six months have remained well below desired levels. In order to fully understand the breastfeeding experience in the early postpartum period and all the intricacies involved, researchers need to provide mothers with the opportunity to talk about their experiences during the time when there are the most difficulties and when they are most likely to discontinue, the first four weeks postpartum. The purpose of this study was to more fully understand, in their own words, the experiences of mothers who began breastfeeding their infant after birth and may or may not have been breasting at four weeks postpartum. A single research question guided this study: What are the lived experiences of breastfeeding mothers during the first four weeks postpartum? Eight mothers who delivered in the past four to six weeks were interviewed. Data were analyzed using a Heideggerian hermeneutic phenomenological approach. This method was chosen because it allowed the researcher to conduct interviews and explore the lived experience of breastfeeding mothers and to uncover the concealed meaning within the phenomena. This methodology provided a richness that might not be possible through description alone. The narratives shared by the mothers demonstrated that initiating breastfeeding and sustaining it in the early postpartum period was a complex process. Each mother’s breastfeeding experience was unique to her but also similar to someone else’s. The overall constitutive pattern of Getting the Hang of It was selected and consisted of four themes and nine subthemes. The four themes included: Physical Experiences, Emotional Complexities, Infant Involvement in Breastfeeding Process, and Support. These themes and their subsequent subthemes provide insight into the complexities experienced by mothers in order to acquire the skills they needed to breastfeed their infants. Breastfeeding mothers, who have had favorable and unfavorable experiences, are willing to share a wealth of information. Health professionals should encourage mothers to talk about their experiences and listen to what they are saying. Through listening they can provide mothers with the resources and support needed to meet their breastfeeding goals.
The Paradox of Respect and Risk: Six Lakota Adolescents Speak
(2009-06-23T21:40:14Z) Isaacson, Mary J; Swenson, Melinda M.; Russell, Kathleen M.; Stiffler, Deborah; Zimmerman, Larry J.
Adolescence is a time of turbulence as young people stretch parental boundaries, seeking where they fit in society. For many American Indian adolescents this time involves the initiation of dangerous high-risk behaviors. Potential causes posed for this are: loss of identity, loss of cultural values and traditions, lack of positive role modeling and feelings of hopelessness. Survey research has been the predominant method of data collection. Very few studies of Native American youth use storytelling, even though stories are a part of many Indian cultures. The primary purpose of this study was to describe the phenomena of respect and risk from the viewpoint of the Lakota adolescent. I employed hermeneutic phenomenology with photography to help the adolescents illuminate these somewhat abstract concepts. I recruited participants from a single reservation on the Northern Plains. I collected data through non-structured interviews and participant observation. I analyzed the data using hermeneutic phenomenology based on Gadamer. Ecological systems theory provided a framework to assist me in understanding the multiple dimensions present in the adolescent’s stories. The phenomena of respect and risk from the perspective of these Lakota adolescents revealed a paradox. Each can be either positive or negative, depending upon the circumstances or the context of the situation. This paradox became the pattern among the participants. The pattern is the rock (inyan) and the wind (tate). The rock and the wind are deeply interconnected, and the influence of one may impact the other. Three themes emerged from this pattern: role modeling (positive or negative), identity, and feeling valued. These themes are consistent with current research regarding adolescent high-risk behaviors. These stories are significant in that they are personal accounts by these adolescents. This study has implications in nursing education, nursing practice, and health policy. Nursing education must attend to teaching students to listen and to become comfortable working with other cultures. As nurses advocate for future programming, it is essential that the research that guides the policies and programming be community-based action research. As society becomes more diverse, nursing must embrace many perspectives, helping all to achieve the highest quality of health and well-being.
Perinatal smoking and its related factors
(2018-07-12) Jones, Ashley; Shieh, Carol; Staten, Lisa; Carter-Harris, Lisa; Stiffler, Deborah; Macy, Jon
The smoking rate of low-income pregnant women is almost 4 times the rate for higher-income women. A better understanding of smoking within the low-income population is needed. The purpose of this dissertation was to study smoking and related factors for pregnant and postpartum women living in poverty. The first component used Rodger’s evolutionary concept analysis method and uncovered three attributes, four antecedents, and three consequences for smoking cessation. The second (N = 1,554) and third (N = 71,944) components were a secondary data analysis of first-pregnancy Medicaid-eligible women enrolled in the Nurse-Family Partnership program from 2011-2016. The second component explored patterns of smoking and depression and their associations. Eight distinct patterns of smoking and depression were found. Smokers were more likely than nonsmokers to have depressive symptoms at the end of pregnancy (OR = 1.37 [1.04, 1.81] and 12 months post-delivery (OR = 1.93 [1.47, 2.51]. The third component investigated covariates present during early pregnancy and their relationships with smoking status and sought to find best fitting predictive models. Multivariable logistic regression showed cigarette use in the 3 months prior to pregnancy and at program intake were significant predictors for smoking status at the end of pregnancy and 12 months post-delivery. Interactive Matrix Language, Structured Query Language, and iterations of logistic regression identified 5 covariates (high school education, cigarette use prior to pregnancy, smoking status at pregnancy baseline, depression, and self-mastery) for the best fitting model at the end of pregnancy and three additional covariates (post-secondary education, marital status, and race) for the 12 months post-delivery model. The area under the receiver operator characteristic curve was 0.9681 for the end of pregnancy model and 0.9269 for 12 months post-delivery model, indicating excellent prediction ability of the models. Results can be integrated in smoking prevention education, screening, and cessation intervention programs.
Racial Equity Considerations In Safe To Sleep Messaging: Learning From The Community
(2019) Stiffler, Deborah; Roessner, K.; Amundson, M; Hapke, L.; Harvey, E.; Sizemore, S.; Smith, S.; Matemachani, S.; Crane, L.
Black infants are dying at a rate of over twice that of White infants. We know that infants in unsafe sleep positions are more likely to die from Sudden Unexpected Infant Death (SUID). Safe to Sleep® education has led to a dramatic decrease in mortality among white infants, but over 60% of Black families do not follow the Safe to Sleep® parameters. Safe to Sleep® education is given to pregnant women during the prenatal period and prior to hospital discharge, but what is the best way to share this message with Black families?

Browsing by Author "Stiffler, Deborah"

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