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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

PRENATAL OBSTETRICS

Noninsulin antidiabetic medications and pregnancy (February 2024)

Noninsulin antidiabetic medications such as glucagon-like peptide 1 (GLP-1) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 (DPP-4) inhibitors are commonly used in nonpregnant individuals but avoided in pregnancy because of lack of safety data in humans and harms observed in animal studies. However, in a multinational population-based cohort study including nearly 2000 individuals with preconception/first trimester exposure to these medications, the frequency of congenital anomalies was not increased compared with insulin [ 1 ]. A limitation of the study is that it did not adjust for potential differences in A1C, diabetes severity, or diabetes duration, which could obscure true effects on risk for congenital anomalies. We continue to avoid use of GLP-1 agonists, SGLT-2 inhibitors, and DPP-4 inhibitors in females planning to conceive and in pregnancy. (See "Pregestational (preexisting) diabetes: Preconception counseling, evaluation, and management", section on 'Patients on preconception noninsulin antihyperglycemic agents' .)

Updates to the United States perinatal HIV clinical guidelines (February 2024)

The United States Department of Health and Human Services has released updates to the perinatal HIV clinical guidelines [ 2 ]. Ritonavir-boosted darunavir is now a preferred agent only for treatment-naïve pregnant individuals who have used cabotegravir-based pre-exposure prophylaxis, because of the concern for integrase inhibitor-resistant mutations; for other pregnant individuals, it is now an alternative rather than preferred agent. Additionally, bictegravir, which was previously not recommended for initial therapy in pregnant individuals, is now an alternative agent based on new pharmacokinetic data that support its use during pregnancy. Our approach to treating HIV during pregnancy is consistent with these updated guidelines. (See "Antiretroviral selection and management in pregnant individuals with HIV in resource-rich settings", section on 'Selecting the third drug' .)

Combined use of metformin and insulin for treating diabetes in pregnancy (February 2024)

In patients with type 2 diabetes, insulin is the mainstay for managing hyperglycemia in pregnancy. The addition of metformin improves maternal glucose control and reduces the chances of a large for gestational age newborn, but a prior randomized trial reported an increased risk for birth of a small for gestational age (SGA) infant. A recent randomized trial comparing use of insulin alone with insulin plus metformin in nearly 800 adult pregnant patients with either preexisting type 2 diabetes or diabetes diagnosed in early pregnancy confirmed the previously reported benefits but found that both treatment groups had low and similar rates of SGA [ 3 ]. The discordancy in SGA risk needs to be explored further, as metformin cotreatment would be undesirable if this risk is real. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Metformin' .)

Fetoplacental GDF15 linked to nausea and vomiting of pregnancy (February 2024)

Almost all pregnant people experience nausea with or without vomiting in early pregnancy; however, the pathogenesis of the disorder has been unclear. Previous studies have shown that GDF15 is expressed in a wide variety of cells, with the highest expression in placental trophoblast, and that its protein (GDF15) appears to regulate appetite. A recent study confirmed the fetoplacental unit as a major source of GDF15 and also found that higher GDF15 levels correlated with more severe nausea and vomiting of pregnancy [ 4 ]. In the future, drugs targeting the production or action of GDF15 are a potential novel pathway for treating nausea and vomiting of pregnancy, if safety and efficacy are established. (See "Nausea and vomiting of pregnancy: Clinical findings and evaluation", section on 'Pathogenesis' .)

Use of cerebroplacental ratio at term does not reduce perinatal mortality (February 2024)

Cerebral blood flow may increase in chronically hypoxemic fetuses to compensate for the decrease in available oxygen and can be assessed by the cerebroplacental ratio (CPR; middle cerebral artery pulsatility index divided by the umbilical artery pulsatility index). However, increasing evidence indicates that use of the CPR does not reduce perinatal mortality in low-risk pregnancies. In a randomized trial comparing fetal growth assessment plus revealed versus concealed CPR in over 11,000 low-risk pregnancies at term, knowledge of CPR combined with a recommendation for delivery if the CPR was <5th percentile did not reduce perinatal mortality compared with usual care (concealed group) [ 5 ]. We do not perform umbilical artery Doppler surveillance, including the CPR, in low-risk pregnancies. (See "Doppler ultrasound of the umbilical artery for fetal surveillance in singleton pregnancies", section on 'Low-risk and unselected pregnancies' .)

Low- versus high-dose calcium supplements and risk of preeclampsia (January 2024)

In populations with low baseline dietary calcium intake, the World Health Organization recommends 1500 to 2000 mg/day calcium supplementation for pregnant individuals to reduce their risk of developing preeclampsia. However, a recent randomized trial that evaluated low (500 mg) versus high (1500 mg) calcium supplementation in over 20,000 nulliparous pregnant people residing in two countries with low dietary calcium intake found low and similar rates of preeclampsia in both groups [ 6 ]. These findings suggest that a 500 mg supplement is sufficient for preeclampsia prophylaxis in these populations. For pregnant adults in the United States, we prescribe 1000 mg/day calcium supplementation, which is the recommended daily allowance to support maternal calcium demands without bone resorption. (See "Preeclampsia: Prevention", section on 'Calcium supplementation' .)

Respectful maternity care (January 2024)

Respectful maternity care is variably defined but broadly involves both absence of disrespectful conduct and promotion of respectful conduct toward pregnant individuals. A systematic review found that validated tools to measure respectful maternity care were available, but the optimal tool was unclear and high quality studies were lacking on the effectiveness of respectful maternity care for improving any maternal or infant health outcome [ 7 ]. Respectful maternal care is a basic human right, but how to best implement and monitor it and assess outcomes requires further study. (See "Prenatal care: Initial assessment", section on 'Effectiveness' .)

Outcome of a multifaceted intervention in patients with a prior cesarean birth (January 2024)

Patients with a pregnancy after a previous cesarean birth must choose between a trial of labor (TOLAC) and a planned repeat cesarean. The optimal care of such patients is unclear. In a multicenter, cluster-randomized trial including over 20,000 patients with one prior cesarean birth, a multifaceted intervention (patient decision support, use of a calculator to assess chances of a vaginal birth after cesarean [VBAC], sonographic measurement of myometrial thickness, clinician training in best intrapartum practices during TOLAC) reduced perinatal and major maternal morbidity composite outcomes compared with usual care [ 8 ]. VBAC and uterine rupture rates were similar for both groups. Further study is needed to identify the most useful component(s) of the intervention for reducing morbidity. (See "Choosing the route of delivery after cesarean birth", section on 'Person-centered decision-making model' .)

Serial amnioinfusions for bilateral renal agenesis (January 2024)

Bilateral renal agenesis (BRA) is incompatible with extrauterine life because prolonged oligohydramnios results in pulmonary hypoplasia, leading to postnatal respiratory failure. A prospective study (RAFT) assessed use of serial amnioinfusions to treat 18 cases of BRA diagnosed at <26 weeks of gestation [ 9 ]. Of the 17 live births, 14 survived ≥14 days and had placement of dialysis access, but only 6 survived to hospital discharge. Of the 4 children alive at 9 to 24 months of age, 3 had experienced a stroke and none had undergone transplant. These findings show that serial amnioinfusions for BRA mitigates pulmonary hypoplasia and increases short-term survival and access to dialysis; however, long-term outcome remains poor with no survival to transplantation. Serial amnioinfusions remain investigational and should be offered only as institutional review board-approved research. (See "Renal agenesis: Prenatal diagnosis", section on 'Investigative role of therapeutic amnioinfusion' .)

Prenatal genetic testing for monogenic diabetes due to glucokinase deficiency (December 2023)

In pregnant individuals with monogenic diabetes due to glucokinase (GCK) deficiency, management depends on the fetal genotype. If the fetus inherits the maternal GCK variant, maternal hyperglycemia will not cause fetal hyperinsulinemia and excessive growth, and maternal hyperglycemia does not require treatment. However, if the fetus does not inherit the pathogenic variant, maternal insulin therapy is indicated to prevent excessive fetal growth. Fetal ultrasound has been used to predict fetal genotype but has limited diagnostic utility. In a cohort of 38 pregnant individuals with GCK deficiency, fetal genetic testing using cell-free DNA in maternal blood had higher sensitivity (100 versus 53 percent) and specificity (96 versus 61 percent) for prenatal diagnosis of GCK deficiency compared with ultrasound measurement of fetal abdominal circumference [ 10 ]. When available, noninvasive prenatal genotyping should be used to guide management of GCK deficiency during pregnancy. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'Glucokinase' .)

Early metformin treatment of gestational diabetes mellitus (November 2023)

Usual initial gestational diabetes mellitus (GDM) care (ie, medical nutritional therapy, exercise) may result in a few weeks of hyperglycemia before a need for pharmacotherapy is established. In a randomized trial evaluating whether initiating metformin at the time of GDM diagnosis regardless of glycemic control improves clinical outcomes compared with usual care, the metformin group had a lower rate of insulin initiation and favorable trends in mean fasting glucose, gestational weight gain, and excessive fetal growth, but more births <2500 grams [ 11 ]. Rates of preeclampsia, neonatal intensive care unit admission, and neonatal hypoglycemia were similar for both groups. Given these mixed results, we recommend not initiating metformin at the time of GDM diagnosis except in a research setting. (See "Gestational diabetes mellitus: Glucose management and maternal prognosis", section on 'Does early metformin initiation improve glycemic control and reduce need for insulin?' .)

Automated insulin delivery in pregnant patients with type 1 diabetes (October 2023)

Hybrid closed-loop insulin therapy is associated with improved glucose control in nonpregnant adults and in children, but little information is available in pregnant people. In the first randomized trial in this population, hybrid closed-loop insulin delivery beginning at 11 weeks gestation improved glycemic control compared with standard insulin therapy in 124 patients with type 1 diabetes, without increasing their risk of severe hypoglycemia [ 12 ]. The system allowed customization of glycemic targets appropriate to pregnancy, in contrast to other commercially available systems in the United States. Additional study is needed to confirm these findings, evaluate the effects on obstetric and neonatal outcomes, and identify optimal candidates. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Continuous subcutaneous insulin infusion (insulin pump)' .)

Valacyclovir for prevention of congenital cytomegalovirus infection (October 2023)

Emerging evidence suggests that maternal administration of valacyclovir for primary cytomegalovirus (CMV) infection substantially reduces the risk of congenital CMV infection, especially if begun prior to 14 weeks of gestation and within 8 weeks of the maternal infection. In a 2023 individual patient data meta-analysis (one randomized trial, two observational studies), maternal valacyclovir administration upon diagnosis of periconception or first-trimester primary CMV infection was associated with a 66 percent reduction in congenital CMV (11 versus 25 percent) [ 13 ]. We suggest high-dose oral valacyclovir (8g per day) for patients with a primary CMV infection in early pregnancy after a comprehensive discussion of the potential benefits and risks (eg, 2 percent risk of reversible maternal kidney failure). (See "Cytomegalovirus infection in pregnancy", section on 'Antiviral medication' .)

Respiratory syncytial virus vaccination in pregnancy (April 2023, Modified October 2023)

Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in infants. In October 2023, the United States Centers for Disease Control and Prevention, along with guidelines from other expert groups, endorsed RSV vaccination of pregnant individuals to reduce severe RSV infections in their infants [ 14-17 ]. Nirsevimab , a monoclonal antibody that can be given to infants postnatally to reduce the risk of severe RSV, has also been recently approved and endorsed by expert guidance panels. In settings where nirsevimab is not available, we suggest vaccination of pregnant individuals between 32 0/6 and 36 6/7 weeks of gestation in September through January (in the northern hemisphere) with inactivated nonadjuvanted recombinant RSV vaccine (RSVPreF; Abrysvo). In settings where both maternal vaccination and nirsevimab are available, the optimal preventive strategy remains uncertain, and, in most cases, it will not be possible to use both. For such patients, both options should be discussed and shared decision-making undertaken. (See "Immunizations during pregnancy", section on 'Choosing the optimal strategy' .)

Revised criteria for pregnancy morbidity in antiphospholipid antibody syndrome (September 2023)

Obstetric antiphospholipid syndrome (APS) is sometimes used to describe patients with pregnancy morbidity, a positive test for antiphospholipid antibodies within three years of the pregnancy morbidity, and findings not attributable to another APS domain. The American College of Rheumatology and European Alliance of Associations for Rheumatology have recently updated the classification criteria for pregnancy morbidity in APS [ 18 ]. Changes included more explicit criteria for gestational age and placental insufficiency ( table 1 ). (See "Antiphospholipid syndrome: Obstetric implications and management in pregnancy", section on 'Adverse pregnancy outcomes defining APS' .)

INTRAPARTUM AND POSTPARTUM OBSTETRICS

Intrauterine postpartum hemorrhage control devices for managing postpartum hemorrhage (February 2024)

Intrauterine balloon tamponade and vacuum-induced uterine compression are the most common devices used for intrauterine postpartum hemorrhage (PPH) control in patients with atony, but it is unclear which device is superior as few comparative studies have been performed. In a retrospective study including nearly 380 patients with PPH, quantitative blood loss after placement, rate of blood transfusion, and discharge hematocrit were similar for both devices [ 19 ]. Based on these and other data, in the setting of ongoing uterine bleeding, rapid use of one of these devices is likely to be more important than the choice of device when both devices are available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Choice of method' .)

Labor epidural analgesia and risk of emergency delivery (December 2023)

It is well established that contemporary neuraxial labor analgesia does not increase the overall risk of cesarean or instrument-assisted vaginal delivery. However, a new retrospective database study of over 600,000 deliveries in the Netherlands reported that epidural labor analgesia was associated with an increased risk of emergency delivery (cesarean or instrument-assisted vaginal) compared with alternative analgesia (13 versus 7 percent) [ 20 ]. Because of potential confounders and lack of detail on epidural and obstetric management, we consider these data insufficient to avoid neuraxial analgesia or change the practice of early labor epidural placement to reduce the potential need for general anesthesia in patients at high risk for cesarean delivery. (See "Adverse effects of neuraxial analgesia and anesthesia for obstetrics", section on 'Effects on the progress and outcome of labor' .)

Delayed cord clamping in preterm births (December 2023)

Increasing evidence supports delaying cord clamping in preterm births. In an individual participant data meta-analysis of randomized trials of delayed versus immediate cord clamping at births <37 weeks (over 3200 infants), delaying cord clamping for >30 seconds reduced infant death before discharge (6 versus 8 percent) [ 21 ]. In a companion network meta-analysis evaluating the optimal duration of delay, a long delay (≥120 seconds) significantly reduced death before discharge compared with immediate clamping; reductions also occurred with delays of 15 to <120 seconds but were not statistically significant [ 22 ]. For preterm births that do not require resuscitation, we recommend delayed rather than immediate cord clamping. We delay cord clamping for at least 30 to 60 seconds as approximately 75 percent of blood available for placenta-to-fetus transfusion is transfused in the first minute after birth. (See "Labor and delivery: Management of the normal third stage after vaginal birth", section on 'Preterm infants' .)

Vacuum-induced intrauterine tamponade for postpartum hemorrhage (November 2023)

Intrauterine tamponade (with a balloon, packing, or vacuum) may be used to manage patients with postpartum hemorrhage (PPH) resulting from uterine atony that is not controlled by uterotonic medications and uterine massage. However, outcome data regarding vacuum-induced tamponade are limited. A study of data from a postmarketing registry of over 500 patients with PPH and isolated atony treated with vacuum-induced tamponade reported that the device controlled bleeding without treatment escalation or bleeding recurrence in 88 percent following cesarean birth and 96 percent following vaginal birth, typically within five minutes [ 23 ]. These data are consistent with previously published outcomes. Given its efficacy and ease of use, vacuum-induced tamponade is an important option for managing PPH in centers where this device is available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Vacuum-induced tamponade' .)

Risk of pregnancy-associated venous and arterial thrombosis in sickle cell disease (November 2023)

Sickle cell disease (SCD) and pregnancy both confer an increased risk of venous thromboembolism (VTE), but the magnitude of the risk is unclear. In a new administrative claims data study involving >6000 people with SCD and >17,000 age- and race-matched controls who were followed for one year postpartum, the risk of VTE was 11.3 percent in the patients with SCD, versus 1.2 percent in controls [ 24 ]. Arterial thromboembolism was also increased (5.2 percent, versus 0.6 percent in controls). This study emphasizes the value of postpartum VTE prophylaxis in people with SCD and the need for vigilance in evaluating suggestive symptoms. (See "Sickle cell disease: Obstetric considerations", section on 'Maternal risks' .)

Racial disparities in anemia during pregnancy (October 2023)

A new study has found that racial disparities in anemia during pregnancy persist and may be increasing. This analysis involved nearly four million births in the state of California from 2011 to 2020 [ 25 ]. Antepartum anemia was most common in Black individuals (22 percent), followed by Pacific Islanders (18 percent), Native American and Alaska Native peoples (14 percent), multiracial individuals (14 percent), Hispanic individuals (13 percent), Asian individuals (11 percent), and White individuals (10 percent). Antepartum anemia is associated with an increase in severe maternal morbidity. The reasons for disparities are multifactorial. (See "Anemia in pregnancy", section on 'Racial disparities' .)

Intrapartum magnesium sulfate before preterm birth and cerebral palsy (October 2023)

Magnesium sulfate is typically administered to pregnant women with impending preterm birth <32 weeks of gestation to decrease the incidence and severity of cerebral palsy in offspring. However, the recent MAGENTA trial comparing the effects of magnesium sulfate versus placebo administered before impending preterm birth between 30 and 34 weeks of gestation found that it did not prevent cerebral palsy among surviving infants [ 26 ]. These findings do not change our current practice because the trial used a single 4 g bolus of magnesium sulfate alone, whereas we also provide an ongoing 1 g/hour infusion until delivery and do not use the medication after 32 weeks; the trial was likely underpowered to find a significant difference. (See "Neuroprotective effects of in utero exposure to magnesium sulfate", section on 'Lower and upper gestational age' .)

OFFICE GYNECOLOGY

Infertility and autism spectrum disorder (December 2023)

Patients with infertility often ask about the impact of the disorder and its treatment on risk of autism spectrum disorder (ASD) in offspring. In a large population-based cohort study comparing ASD risk among children whose parents had subfertility (an infertility consultation without treatment), infertility treatment, or neither (unassisted conception), children in the subfertility and infertility treatment groups had a small increased risk of ASD compared with unassisted conception but the absolute risk was low (2.5 to 2.7 per 1000 person-years versus 1.9 per 1000 person-years with unassisted conception) [ 27 ]. The increased risk was similar in the subfertile and infertility treatment groups, suggesting that infertility treatment was not a major risk factor. Obstetrical and neonatal factors (eg, preterm birth) appeared to mediate a sizeable proportion of the increased risk for ASD. (See "Assisted reproductive technology: Infant and child outcomes", section on 'Confounders' .)

Macular changes related to pentosan polysulfate sodium (November 2023)

Macular eye disease has been reported in patients who have taken pentosan polysulfate sodium (PPS), which is used for the treatment of interstitial cystitis. In a prospective cohort study of 26 eyes with PPS maculopathy and >3000 g cumulative PPS exposure, progression of macular changes continued 13 to 30 months after drug cessation [ 28 ]. Median visual acuity decreased slightly; most patients reported progression of symptoms, including difficulty in low-light environments and blurry vision. These results indicate that PPS maculopathy progresses despite drug discontinuation, underscoring the importance of regular screening for maculopathy in patients with current or prior PPS exposure. (See "Interstitial cystitis/bladder pain syndrome: Management", section on 'Pentosan polysulfate sodium as alternative' .)

Vaginal laser therapy not effective for genitourinary syndrome of menopause (November 2023)

Laser devices, including the fractional microablative CO 2 laser, have been marketed for treatment of patients with genitourinary syndrome of menopause (GSM), but data regarding their safety and efficacy are limited. In a randomized trial including nearly 50 postmenopausal patients with GSM, treatment with CO 2 laser did not improve symptom severity compared with sham therapy [ 29 ]. Change in vaginal histology, which is a common surrogate determinant of treatment success, was similar in both groups at six months postprocedure. In addition, histologic features associated with a hypoestrogenic state correlated poorly with the severity of vaginal symptoms. Although the trial had limitations, these findings are consistent with other data and support our practice of not using laser treatment for patients with GSM. (See "Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment", section on 'Laser or radiofrequency devices' .)

Use of vaginal estrogen in breast cancer patients taking aromatase inhibitors (October 2023)

Use of vaginal estrogen to manage symptoms of genitourinary syndrome of menopause (GSM) may be harmful in patients with breast cancer on aromatase inhibitors (AIs). In a subgroup analysis of a claims-based analysis, vaginal estrogen therapy was associated with a higher rate of breast cancer recurrence in patients taking versus not taking an AI [ 30 ]. Time to recurrence in the AI group was approximately 140 days. While this study had many limitations, these data support our general practice of avoiding vaginal estrogen for the management of GSM in most patients with breast cancer taking AIs. (See "Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment", section on 'Patients with breast cancer' .)

GYNECOLOGIC SURGERY

Risk of unplanned hysterectomy at time of myomectomy (February 2024)

Myomectomy is an option for patients with bothersome fibroid symptoms (eg, bleeding, bulk); however, data are limited regarding the risk of unplanned hysterectomy at the time of myomectomy. In a retrospective study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2010 to 2021 including over 13,000 patients undergoing myomectomy, the risk of unplanned hysterectomy was higher in those undergoing laparoscopic myomectomy compared with an open abdominal or hysteroscopic approach (7.1, 3.2, and 1.9 percent respectively) [ 31 ]. While much lower risks have been reported (<0.4 percent), and expert surgeons at high-volume centers may have fewer conversions to hysterectomy, this study highlights the importance of discussing the risk of unplanned hysterectomy during the informed consent process. (See "Uterine fibroids (leiomyomas): Laparoscopic myomectomy and other laparoscopic treatments", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Open abdominal myomectomy procedure", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Hysteroscopic myomectomy", section on 'Unplanned hysterectomy' .)

Risk of subsequent hysterectomy after endometrial ablation (January 2024)

Endometrial ablation is an alternative to hysterectomy in selected premenopausal patients with heavy menstrual bleeding. Most ablations are performed using a non-resectoscopic technique; however, the long-term efficacy of this approach is unclear. In a meta-analysis of 53 studies including over 48,000 patients managed with non-resectoscopic endometrial ablation (NREA), the rates of subsequent hysterectomy were 4 percent at 12 months, 8 to 12 percent at 18 to 60 months, and 21 percent at 120 months [ 32 ]. Hysterectomy rates were similar for the different NREA devices (eg, thermal balloon, microwave, radiofrequency). These findings are useful for counseling patients about the long-term risk for hysterectomy after NREA. (See "Endometrial ablation: Non-resectoscopic techniques", section on 'Efficacy' .)

Pregnancy and childbirth after urinary incontinence surgery (January 2024)

Patients with stress urinary incontinence (SUI) have historically been advised to delay midurethral sling (MUS) surgery until after childbearing because of concerns for worsening SUI symptoms following delivery. In a meta-analysis of patients with MUS surgery who were followed for a mean of nearly 10 years, similar low SUI recurrence and reoperation rates were reported for the 381 patients with and the 860 patients without subsequent childbirth [ 33 ]. Birth route did not affect the findings. Although the total number of recurrences and reoperations was small, this study adds to the body of evidence suggesting that subsequent childbirth does not worsen SUI outcomes for patients who have undergone MUS. (See "Surgical management of stress urinary incontinence in females: Retropubic midurethral slings", section on 'Subsequent pregnancy' .)

GYNECOLOGIC ONCOLOGY

Increasing incidence of cervical and uterine corpus cancer in the United States (February 2024)

In January 2024, the American Cancer Society published their annual report of cancer statistics in the United States [ 34 ]. Notable trends in regard to gynecologic cancers include a 1.7 percent increase in the annual incidence of cervical cancer from 2012 to 2019 in individuals aged 30 to 44 years, after decades of decline. Cancer of the uterine corpus (all ages) continued to increase by approximately 1 percent annually and was the only cancer in the report in which survival decreased. These and other data emphasize the continued importance of both early detection and prevention (eg, for cervical cancer: human papillomavirus vaccination and screening for precursor lesions; for endometrial cancer: achieving and maintaining a normal body mass index). (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis", section on 'Incidence and mortality' and "Endometrial carcinoma: Epidemiology, risk factors, and prevention", section on 'Epidemiology' and "Endometrial carcinoma: Clinical features, diagnosis, prognosis, and screening", section on 'Prognosis' .)

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  • Oderkerk TJ, Beelen P, Bukkems ALA, et al. Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:51.
  • Nahshon C, Abramov Y, Kugelman N, et al. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence following midurethral sling procedure: a meta-analysis. Am J Obstet Gynecol 2024; 230:308.
  • Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024; 74:12.

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30+ Research Topics on Obstetrics and Gynecology Nursing

  • Carla Johnson
  • August 24, 2023
  • Nursing Topics and Ideas

Obstetrics and Gynecology Nursing (OB-GYN nursing) is a specialized field within nursing that focuses on providing comprehensive care to women throughout their reproductive journeys. This includes pregnancy, childbirth, and menopause. For nursing students, grasping the nuances of OB-GYN nursing is crucial for delivering effective and compassionate care . This article delves into OB-GYN nursing, exploring PICOT questions, project concepts, research topics, and essay ideas to deepen nursing students’ understanding.

Exploring PICOT Questions in Obstetrics and Gynecology Nursing

  • P: Adolescent Pregnancies ; I: Comprehensive Sex Education Programs; C: Conventional Health Education; O: Decreased Teen Pregnancy Rates; T: 2 Years. Assessing if introducing comprehensive sex education programs reduces teen pregnancy rates over two years.
  • P: Perinatal Women; I: Mindfulness-Based Stress Reduction; C: Standard Care; O: Lowered Anxiety and Depression; T: 6 Months. Investigating whether mindfulness-based stress reduction reduces anxiety and depression in perinatal women over six months.
  • P: PCOS-Affected Women; I: Low-Glycemic Diet; C: Regular Diet; O: Improved Hormonal Balance; T: 3 Months. Examining if a low-glycemic diet enhances hormonal balance in women with PCOS over three months.
  • P: Postmenopausal Women; I: Strength Training; C: Sedentary Lifestyle; O: Increased Bone Density; T: 1 Year. Determining whether strength training improves bone density in postmenopausal women within a year.
  • P: Hysterectomy Patients; I: Laparoscopic Surgery; C: Open Abdominal Surgery; O: Quicker Recovery; T: 4 Weeks. Comparing laparoscopic and open abdominal surgeries to identify a faster recovery option for hysterectomy patients within four weeks.
  • P: Pregnant Women; I: Prenatal Genetic Testing; C: No Genetic Testing ; O: Informed Decisions; T: Pregnancy Duration. Exploring how offering prenatal genetic testing influences informed decisions by pregnant women.
  • P: Endometriosis Patients; I: Acupuncture Therapy; C: Standard Pain Management; O: Reduced Pelvic Pain; T: 3 Months. Investigating acupuncture therapy’s impact on pelvic pain reduction in endometriosis patients over three months.
  • P: Gestational Diabetes Women; I: Continuous Glucose Monitoring ; C: Intermittent Monitoring; O: Better Glucose Control; T: Pregnancy Course. Assessing if continuous glucose monitoring improves glucose control in gestational diabetes women compared to intermittent monitoring.
  • P: Urinary Incontinence Sufferers; I: Pelvic Floor Exercises; C: No Exercise; O: Enhanced Bladder Control; T: 6 Weeks. Studying if pelvic floor exercises lead to better bladder control in women with urinary incontinence over six weeks.
  • P: Potential IUD Users; I: Detailed Counseling; C: Brief Counseling; O: Informed Choices; T: Pre-IUD Insertion. Investigating the impact of counseling intensity on informed decision-making among potential IUD users before insertion.

EBP Ideas on Obstetrics and Gynecology Nursing

  • Telehealth in Prenatal Care : Evaluating the effectiveness of telehealth services for remote prenatal care.
  • Nutrition and Gestational Diabetes: Investigating nutrition education’s role in gestational diabetes management.
  • Alternative Labor Pain Management: Analyzing hydrotherapy’s effectiveness in labor pain management.
  • Breastfeeding Support Groups: Assessing breastfeeding support groups’ impact on successful breastfeeding.
  • VBAC vs. Repeat C-Section: Comparing outcomes of vaginal birth after cesarean versus repeat cesarean sections.
  • Midwifery’s Impact: Examining midwives’ role in improving maternal and neonatal outcomes.
  • Aromatherapy in Labor: Investigating aromatherapy’s role in managing labor pain and anxiety.
  • Maternal Obesity Effects: Exploring maternal obesity’s impact on pregnancy outcomes.
  • Preoperative Education: Evaluating preoperative education’s impact on anxiety reduction in gynecological surgery patients.
  • Culturally Sensitive Care: Analyzing the effect of culturally sensitive care on patient satisfaction in OB-GYN settings.

Capstone Project Concepts on Obstetrics and Gynecology Nursing

  • Postpartum Depression Screening Protocol: Developing a protocol for postpartum depression screening in OB-GYN clinics.
  • Adolescent Sexual Health Education: Designing an educational program on sexual health and contraceptives for adolescents.
  • Infertility Resource Guide: Creating a guide for infertility treatment options and emotional support.
  • Perinatal Loss Support Program: Implementing a support program for families experiencing stillbirth or neonatal death.
  • Menstrual Cycle Tracking App: Designing an app for menstrual cycle tracking with educational components.
  • Underserved Prenatal Care: Establishing a community outreach initiative for free prenatal care in underserved areas.
  • Menopause Education Curriculum: Developing an education curriculum for menopausal women.
  • Trauma-Informed Care Training: Creating a training module for nurses on trauma-informed care for survivors of sexual assault.
  • Intimate Partner Violence Protocol: Implementing a protocol for identifying and assisting victims of intimate partner violence in OB-GYN settings.
  • Gender-Affirming Care: Designing a care framework for transgender and non-binary individuals in OB-GYN settings.

Research Topics on Obstetrics and Gynecology Nursing

  • Maternal Stress and Fetal Development: The impact of maternal stress on fetal development and long-term outcomes.
  • Cultural Influences on Childbirth: How cultural factors shape childbirth practices and maternal health behaviors.
  • Addressing Maternal Mortality: Strategies to reduce maternal mortality rates in developing nations.
  • Healthcare Disparities in Reproductive Health: Exploring access inequalities in reproductive healthcare for marginalized communities.
  • OB-GYN Nurses in Family Planning: The role of OB-GYN nurses in promoting contraception education and family planning.
  • Ethical Issues in Maternal-Fetal Medicine: Ethical considerations in prenatal genetic testing and maternal-fetal care.
  • Hormonal Contraception and Mental Health: Examining the connection between hormonal contraception use and women’s mental health.
  • Advancements in Labor Pain Management: Innovations in pain management during labor and childbirth.
  • Menopause and Cardiovascular Health: The intersection of menopause and cardiovascular health: Nursing implications.
  • Transgender and Non-Binary Care: Providing gender-affirming care for transgender and non-binary individuals.

Research Questions on Obstetrics and Gynecology

  • Fetal Neurological Development: How does prenatal maternal stress affect fetal neurological development?
  • Cultural Competence in Maternal Care: What is the significance of cultural competence in maternity care?
  • Effective Strategies for Maternal Mortality: Which interventions are effective in reducing maternal mortality in resource-limited settings?
  • Reproductive Healthcare Disparities: How does socioeconomic status contribute to reproductive healthcare disparities?
  • OB-GYN Nurses’ Role in Contraception Education: What are the essential aspects of effective contraception counseling by OB-GYN nurses?
  • Ethical Challenges in Prenatal Genetic Testing : What ethical challenges arise in prenatal genetic testing, and how do nurses address them?
  • Hormonal Contraception and Mental Health: Is there a causal link between hormonal contraception use and women’s mental health?
  • Optimal Labor Pain Management Techniques: What evidence supports the best labor pain management techniques?
  • Cardiovascular Risks in Menopausal Women: How can nurses identify cardiovascular risks in menopausal women?
  • Affirming Care for Transgender Individuals: What are the unique healthcare needs of transgender individuals in OB-GYN settings?

20 Inspiring Essay Topics and Examples

  • Maternal-Child Bond: Analyzing the impact of early maternal-child bonding on long-term health.
  • Ethical Dilemmas in OB-GYN Nursing: Examining ethical challenges and proposing solutions.
  • Evolution of Birth Control Methods: Tracing the development of contraception methods and their societal impact.
  • Cultural Competence in Maternity Care: Importance and ways to provide culturally competent care.
  • Advancements in Fetal Monitoring: Exploring cutting-edge technologies for maternal and fetal health.
  • Empowering Women Through Menopause: Strategies for supporting women during the menopausal transition.
  • Adolescent Reproductive Health: OB-GYN nurses’ role in educating adolescents about reproductive health.
  • Maternal Nutrition and Fetal Development: Linking maternal nutrition to fetal growth and development.
  • Racial Disparities in Maternal Healthcare: Examining racial disparities and proposing interventions.
  • Impact of Endometriosis Beyond Pain: Understanding emotional and psychological aspects.
  • Holistic Approach in Childbirth: The philosophy and practices of midwifery in maternity care.
  • Men’s Involvement in Maternal Health: Importance of men’s role in maternal care and support.
  • Challenges of Maternal Obesity: Analyzing challenges in caring for obese pregnant women.
  • Supporting Families Through Stillbirth: Emotional and psychological support for families.
  • OB-GYN Nurses in Family Planning: Multifaceted roles of nurses in family planning clinics.
  • Personalized Obstetrics: The potential of personalized medicine in maternal and fetal care.
  • Reproductive Choices in the Modern Era: Analyzing reproductive choices’ array and implications.
  • Mental Health and Infertility: Exploring emotional tolls and nursing support for infertility.
  • Mind-Body Techniques in Childbirth: Integrating mind-body techniques for childbirth preparation.
  • Redefined Postpartum Care: Innovative approaches to postpartum care and wellness.

As you journey into obstetrics and gynecology nursing, seize opportunities to deepen your knowledge and impact. Engage in research, projects, and essays contributing to this vital field. If you need assistance crafting compelling content, don’t hesitate to explore our professional writing services . These services can guide you in effectively conveying your ideas. Remember, each step in learning and skill development brings you closer to becoming a proficient and empathetic OB-GYN nurse.

Frequently Asked Questions (FAQs)

Q1: What is obstetrics and gynecological nursing?

A1: Obstetrics and gynecological nursing is a specialized field that focuses on providing comprehensive healthcare to women across various stages of their reproductive lives, encompassing pregnancy, childbirth, and women’s health concerns.

Q2: What do nurses do in gynecology?

A2: Nurses in gynecology assist with various procedures and examinations, educate patients about reproductive health , administer medications, and provide emotional support to patients during gynecological treatments and interventions.

Q3: What skills do you need to be a nurse in gynecology?

A3: To be a successful gynecology nurse, you need strong communication skills, proficiency in patient education, expertise in assisting with gynecological procedures, and the ability to provide compassionate care tailored to women’s needs.

Q4: What are the roles of nurses in the obstetric unit?

A4: Nurses in the obstetric unit play pivotal roles, including monitoring maternal and fetal well-being, assisting in labor and childbirth, administering medications, providing breastfeeding support, and offering emotional guidance to expectant mothers .

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Obstetric and Gynecological Nursing Research Paper Topics

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The diverse array of obstetric and gynecological nursing research paper topics underscores the critical importance of this specialized field of nursing. Obstetric and gynecological nursing encompasses a wide range of topics that address the health and wellness of women from adolescence through menopause and beyond. This includes the management of pregnancy and childbirth, preventive care, and the diagnosis and treatment of diseases and disorders specific to women. As the healthcare needs of women continue to evolve, so does the need for ongoing research and development of evidence-based practices in obstetric and gynecological nursing. This article provides a comprehensive list of research paper topics that will be of interest to students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

100 Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is a specialized field of nursing that focuses on the health and well-being of women throughout their lifespan. It encompasses a wide range of topics including pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, reproductive health, maternal and newborn health, high-risk pregnancy, women’s health across the lifespan, menopausal health, and ethical and legal issues in obstetric and gynecological nursing. The significance of this field cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. This article provides a comprehensive list of obstetric and gynecological nursing research paper topics, divided into 10 categories, each containing 10 topics.

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Pregnancy and Prenatal Care:

  • The role of prenatal vitamins in preventing birth defects.
  • The effects of maternal stress on fetal development.
  • The impact of prenatal exercise on maternal and fetal health.
  • The role of routine ultrasound examinations in prenatal care.
  • The effectiveness of non-pharmacological interventions for nausea and vomiting during pregnancy.
  • The impact of maternal obesity on pregnancy outcomes.
  • The role of folic acid supplementation in the prevention of neural tube defects.
  • The effectiveness of smoking cessation interventions during pregnancy.
  • The impact of maternal alcohol consumption on fetal development.
  • The role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery:

  • The effectiveness of epidural analgesia in managing labor pain.
  • The impact of birthing positions on labor outcomes.
  • The role of continuous support during labor and delivery.
  • The effectiveness of non-pharmacological pain relief methods during labor.
  • The impact of induced labor on maternal and neonatal outcomes.
  • The role of midwives in managing labor and delivery.
  • The effectiveness of water birth in reducing labor pain.
  • The impact of cesarean section on maternal and neonatal outcomes.
  • The role of intrapartum fetal monitoring in preventing adverse outcomes.
  • The effectiveness of active management of the third stage of labor in preventing postpartum hemorrhage.

Postpartum Care:

  • The role of breastfeeding support in promoting successful breastfeeding.
  • The impact of postpartum depression on mother-infant bonding.
  • The effectiveness of skin-to-skin contact in promoting neonatal thermoregulation.
  • The role of postpartum exercise in promoting maternal physical and mental health.
  • The impact of early postpartum discharge on maternal and neonatal outcomes.
  • The effectiveness of postpartum contraceptive counseling in preventing unplanned pregnancies.
  • The role of routine newborn screening in the early detection of congenital disorders.
  • The impact of maternal-infant rooming-in on breastfeeding success.
  • The effectiveness of postpartum home visits in promoting maternal and newborn health.
  • The role of pelvic floor exercises in preventing postpartum urinary incontinence.

Gynecological Disorders:

  • The effectiveness of hormonal therapy in managing polycystic ovary syndrome.
  • The impact of lifestyle modifications on the management of endometriosis.
  • The role of screening in the early detection of cervical cancer.
  • The effectiveness of non-surgical interventions for uterine fibroids.
  • The impact of human papillomavirus vaccination on the incidence of cervical cancer.
  • The role of hormonal replacement therapy in managing menopausal symptoms.
  • The effectiveness of conservative management for ovarian cysts.
  • The impact of early detection and treatment on the prognosis of ovarian cancer.
  • The role of lifestyle modifications in the prevention of gynecological cancers.
  • The effectiveness of surgical interventions for pelvic organ prolapse.

Reproductive Health:

  • The role of contraceptive counseling in preventing unplanned pregnancies.
  • The impact of long-acting reversible contraceptives on reducing the rate of unintended pregnancies.
  • The effectiveness of fertility awareness-based methods in preventing pregnancy.
  • The role of preconception care in promoting healthy pregnancies.
  • The impact of sexually transmitted infections on reproductive health.
  • The effectiveness of barrier methods in preventing sexually transmitted infections.
  • The role of hormonal contraceptives in managing menstrual disorders.
  • The impact of infertility on mental health.
  • The effectiveness of assisted reproductive technologies in managing infertility.
  • The role of male involvement in promoting reproductive health.

Maternal and Newborn Health:

  • The impact of gestational diabetes on maternal and neonatal outcomes.
  • The effectiveness of kangaroo mother care in promoting neonatal health.
  • The role of antenatal corticosteroids in preventing neonatal respiratory distress syndrome.
  • The impact of maternal anemia on neonatal outcomes.
  • The effectiveness of newborn resuscitation in preventing neonatal mortality.
  • The role of immunization in promoting maternal and newborn health.
  • The impact of maternal mental health on neonatal outcomes.
  • The effectiveness of neonatal intensive care in improving the survival of preterm infants.
  • The role of early intervention services in promoting the development of high-risk infants.
  • The impact of maternal-infant bonding on neonatal outcomes.

High-Risk Pregnancy:

  • The role of antenatal care in managing high-risk pregnancies.
  • The impact of multiple pregnancies on maternal and neonatal outcomes.
  • The effectiveness of nutritional interventions in managing gestational diabetes.
  • The role of bed rest in managing preterm labor.
  • The impact of advanced maternal age on pregnancy outcomes.
  • The effectiveness of antihypertensive medications in managing preeclampsia.
  • The role of fetal surveillance in managing intrauterine growth restriction.
  • The impact of preconception care on the outcomes of high-risk pregnancies.
  • The effectiveness of interventions for preventing recurrent preterm birth.
  • The role of specialist care in managing high-risk pregnancies.

Women’s Health Across the Lifespan:

  • The impact of lifestyle modifications on the prevention of cardiovascular diseases in women.
  • The effectiveness of breast cancer screening in early detection and treatment.
  • The role of hormone replacement therapy in managing menopausal symptoms.
  • The impact of osteoporosis on women’s health.
  • The effectiveness of interventions for preventing urinary incontinence in women.
  • The role of regular exercise in promoting mental health in women.
  • The impact of domestic violence on women’s health.
  • The effectiveness of interventions for promoting healthy eating in women.
  • The role of stress management in preventing chronic diseases in women.
  • The impact of depression on women’s health.

Menopausal Health:

  • The impact of menopause on cardiovascular health.
  • The effectiveness of hormonal replacement therapy in managing menopausal symptoms.
  • The role of lifestyle modifications in managing menopausal weight gain.
  • The impact of menopause on mental health.
  • The effectiveness of non-hormonal interventions for managing hot flashes.
  • The role of regular exercise in preventing osteoporosis in postmenopausal women.
  • The impact of menopause on sexual health.
  • The effectiveness of dietary interventions in managing menopausal symptoms.
  • The role of stress management in promoting menopausal health.
  • The impact of menopause on the risk of developing gynecological cancers.

Ethical and Legal Issues in Obstetric and Gynecological Nursing:

  • The role of informed consent in obstetric and gynecological procedures.
  • The impact of religious and cultural beliefs on women’s health decisions.
  • The effectiveness of mandatory reporting of domestic violence in promoting women’s safety.
  • The role of confidentiality in obstetric and gynecological care.
  • The impact of legal restrictions on abortion services.
  • The effectiveness of legal interventions in preventing female genital mutilation.
  • The role of ethical considerations in assisted reproductive technologies.
  • The impact of legal and ethical issues on the practice of obstetric and gynecological nursing.
  • The effectiveness of legal interventions in promoting maternal and newborn health.
  • The role of ethical considerations in the management of high-risk pregnancies.

The importance of research in obstetric and gynecological nursing cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. The diverse range of topics listed above provides a comprehensive overview of the various aspects of obstetric and gynecological nursing. It is our hope that this list will serve as a valuable resource for students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

The Range of Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is an essential branch of healthcare that focuses on the well-being of women during pregnancy, childbirth, and the postpartum period, as well as the diagnosis and treatment of diseases of the female reproductive system. The significance of this field is immense, as it plays a crucial role in ensuring the health and safety of both mothers and newborns, and in managing and preventing gynecological disorders. The scope of obstetric and gynecological nursing research paper topics is vast, encompassing a wide range of issues from pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, and much more.

Pregnancy and Prenatal Care

Proper care during pregnancy is essential for the health and well-being of both the mother and the baby. Prenatal care involves a series of regular check-ups and screenings to monitor the health of the mother and the developing fetus. Obstetric nurses play a crucial role in providing this care, educating expectant mothers about proper nutrition, exercise, and lifestyle habits, monitoring the progress of the pregnancy, and identifying and managing any potential complications. Some obstetric and gynecological nursing research paper topics in this area could include the effectiveness of different prenatal screening tests, the impact of maternal lifestyle habits on fetal development, or the role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery

The process of labor and delivery is a critical period that requires skilled care and management to ensure the safety of both the mother and the baby. Obstetric nurses are involved in every stage of this process, from monitoring the progress of labor, providing pain relief, assisting with the delivery, and caring for the mother and newborn immediately after birth. Research topics in this area could include the effectiveness of different pain relief methods during labor, the impact of birthing positions on labor outcomes, or the role of continuous support during labor and delivery.

Postpartum Care

The postpartum period, or the time after childbirth, is a crucial time for both the mother and the newborn. Obstetric nurses provide care to the mother as she recovers from childbirth, monitor the newborn’s health and development, provide breastfeeding support, and educate the new parents on infant care. Some potential obstetric and gynecological nursing research paper topics in this area could include the impact of postpartum depression on mother-infant bonding, the effectiveness of skin-to-skin contact in promoting neonatal thermoregulation, or the role of postpartum exercise in promoting maternal physical and mental health.

Gynecological Disorders

Gynecological nursing involves the diagnosis and treatment of diseases of the female reproductive system. Gynecological nurses provide care to women with a variety of gynecological disorders such as polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, cervical cancer, and more. Research topics in this area could include the effectiveness of hormonal therapy in managing PCOS, the impact of lifestyle modifications on the management of endometriosis, or the role of screening in the early detection of cervical cancer.

The diverse range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore a variety of issues that affect women’s health. By conducting research in this field, nurses can contribute to the body of knowledge that informs clinical practice and helps improve outcomes for women and newborns.

In conclusion, obstetric and gynecological nursing is a vital field that plays a crucial role in ensuring the health and well-being of women and newborns. From pregnancy and prenatal care, labor and delivery, postpartum care, and the management of gynecological disorders, the scope of this field is vast. The wide range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore various aspects of this field and contribute to the improvement of women’s health.

iResearchNet’s Custom Writing Services

Are you a nursing student overwhelmed with assignments, or simply looking for quality research materials for your obstetric and gynecological nursing research paper? Look no further than iResearchNet, your trusted partner in academic excellence. At iResearchNet, we understand the importance of submitting well-researched, well-written, and original papers, and that’s why we are dedicated to providing you with top-notch writing services that will not only earn you top grades but also enhance your understanding of the subject matter.

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  • Expert Degree-Holding Writers : Our team consists of highly qualified writers with advanced degrees in nursing and related fields. They have extensive experience in academic writing and are well-versed in various obstetric and gynecological nursing topics. You can be confident that your paper will be handled by a professional with a deep understanding of the subject matter.
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Your Success Starts Here!

Every nursing student understands the importance of submitting high-quality research papers. Not only do they contribute significantly to your final grade, but they also reflect your understanding and knowledge of the subject matter. Obstetric and gynecological nursing is a crucial area of study that demands thorough research and a comprehensive understanding of various topics. As a student, you may sometimes find yourself overwhelmed with multiple assignments, leaving you with limited time to complete your research paper. This is where iResearchNet comes in. We are here to support you in your academic journey by providing custom obstetric and gynecological nursing research papers that will not only earn you top grades but also enhance your understanding of the subject matter.

Why stress yourself with tight deadlines, or worry about the quality of your research paper when you can have it all taken care of by professionals? At iResearchNet, we understand the challenges that nursing students face, and that’s why we are committed to providing top-notch writing services tailored to your specific needs. With our team of expert degree-holding writers, you can be confident that your paper will be well-researched, well-written, and original. Our writers carry out in-depth research using the most recent and credible sources to ensure that your paper is informative and well-grounded. Additionally, we offer custom formatting in various styles, including APA, MLA, Chicago/Turabian, and Harvard, to ensure that your paper meets the requirements of your institution.

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Research Topics & Ideas: Nursing

50+ Nursing Research Topic Ideas To Fast-Track Your Project

Research topics for nursing dissertations and theses

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a nursing-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of nursing-related research ideas and topic thought-starters, including general nursing, medical-surgical nursing, pediatric nursing, obstetrics and gynaecological nursing, ICU and mental health nursing.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the nursing domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic. 

Overview: Nursing Research Topics

  • General nursing-related topics
  • Medical-surgical nursing
  • Pediatric nursing
  • Obstetrics and gynaecological nursing
  • ICU nursing
  • Mental health nursing

General Nursing Research Topics & Ideas

  • The impact of cultural competence on patient care in the UK
  • The importance of evidence-based practice in nursing for patients with HIV/AIDS
  • The effects of workplace stress on nurse well-being and performance
  • The role of nurse-patient communication for patients transitioning from adolescent to adult care
  • The impact of technology on nursing practice and patient outcomes
  • The importance of interdisciplinary collaboration in healthcare for the rehabilitation of patients post-surgery
  • The effects of fatigue on nurse performance in the emergency room
  • The impact of nurse staffing levels on patient outcomes in rural areas
  • The effectiveness of nurse-led interventions in managing chronic conditions: a case study of diabetes
  • The impact of patient-centred care on health outcomes for the elderly
  • The importance of patient safety in nursing: bedside nurse vigilance
  • The effects of empathy and compassion in critical care nursing
  • The role of nursing in disaster preparedness and response: a case study of the Haiti earthquake of 2021
  • The impact of the level of nursing education on patient outcomes
  • The importance of ethical considerations in frail care nursing practice

Topics & Ideas: Medical-Surgical Nursing

  • The impact of bedside care on patient outcomes in medical-surgical units
  • The role of the nurse in managing post-operative patient pain
  • The effects of nurse-patient ratios on patient outcomes in medical-surgical units
  • A systematic review of different approaches to patient education in medical-surgical units
  • The relationship between nurse-patient communication and patient satisfaction in medical-surgical units: perspectives and recommendations to improving patient satisfaction

Topics & Ideas: Pediatrics Nursing

  • The impact of family-centered care on pediatric patient outcomes with sickle cell anemia
  • The role of nursing interventions in promoting developmental and behavioral health in pediatric patients
  • The effects of play therapy on anxiety and pain in pediatric patients during hospitilisation
  • A systematic review of different approaches to pain management in pediatric cancer patients
  • The relationship between parent involvement and post-operative patient outcomes in pediatric units

Research topic idea mega list

Ideas: Obstetrics and Gynecological Nursing

  • The impact of nurse-led prenatal care on maternal and fetal outcomes in African American communities
  • The role of the nurse in promoting sexual and reproductive health for women in the UK
  • The effects of midwifery care on maternal satisfaction of primiparous women and birth outcomes
  • A comparative study of different approaches to childbirth education for expectant mothers and partners: perceptions of control
  • The relationship between lactation support and breastfeeding success of primiparous women

Topics & Ideas: ICU Nursing

  • The impact of nursing interventions on patient outcomes in intensive care units in a developing country
  • The role of the nurse in managing palliative and end-of-life care in the ICU
  • The effects of family presence on patient outcomes and satisfaction in the ICU: A systematic review of the literature
  • A comparative study of different approaches to pain management for trauma patients in the ICU
  • The relationship between nurse-patient communication and geriatric patient outcomes in ICU

Research topic evaluator

Topics & Ideas: Mental Health Nursing

  • The impact of nurse-led therapy on adolescent patient outcomes in mental health settings
  • The role of the nurse in promoting recovery and resiliency in mental health patients through group interventions
  • The effects of mindfulness-based interventions on stress and anxiety in mental health patients: A systematic literature review
  • A comparative study of the role of nurses in applying different approaches to patient education in mental health settings
  • The association between nurse-patient therapeutic alliance and patient outcomes in mental health settings

Nursing Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a nursing-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various nursing-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

  • Nursing Workload and Interventions of Licensed Nurses in Nursing Homes: An Observational Time and Motion Study (Kang, 2021)
  • Missed Nursing Care: Accounting for Education, Experience, and Job Satisfaction in Registered Nurses (Bechard, 2021)
  • Examining Predictors of Attitudes and Knowledge of Registered Nurses and Nursing Students in Tennessee toward Pregnant and Perinatal Women with a Substance Use Disorder (Patrylo, 2021)
  • A Program Evaluation of the Organizational Readiness for Pathway to Excellence at Two Community Hospitals  (Behling, 2021)
  • The Impact of Covid-19 Pandemic Policy Decisions on the Wellbeing of Nursing Home Residents in Missouri (White, 2022)
  • Battling A Parallel Pandemic: An Evaluation of Sustainable System-Level Nursing Support in Response To COVID-19 (Gifford, 2022)
  • Holistic Nursing Process Maps: a Tool for Student Nurses to Operationalize the Nursing Process to Increase Clinical Reasoning (Reyes, 2022)
  • Satisfaction and Work-Life Balance in Undergraduate Nursing Faculty: A Mixed-Methods Study (Crawford, 2021)
  • The Effect of Mindfulness Meditation on the Stress, Anxiety, Mindfulness, and Self-Compassion Levels of Nursing Students (Heinrich, 2022)
  • Effectiveness of Simulation-Based Case Studies in Undergraduate Nursing Students (Becnel, 2022)
  • A Telehealth Simulation Experiment: Exploring Prebriefing (Owen, 2022)
  • Perceptions of Lateral Violence Among Vocational Nursing Students, Associate Degree Nursing Students, and Bachelor’s Degree Nursing Students (Martha, 2022)
  • Nurse Educators’ Description of Ethics from a Disciplinary Perspective: A Qualitative Descriptive Research Study (Cuchetti, 2022)
  • A Literature Review of the Relationship Between Oral Health and Pneumonia Risk in the Geriatric Nursing Home Population (Swift, 2021)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

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Nursing research in obstetrics and gynaecology

  • PMID: 6926006
  • DOI: 10.1016/0020-7489(82)90003-7
  • Infant, Newborn
  • Labor, Obstetric
  • Midwifery* / trends
  • Obstetric Nursing* / trends
  • Preoperative Care

nursing research topics related to obg

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Best Nursing Research Topics for Students

What is a nursing research paper.

  • What They Include
  • Choosing a Topic
  • Best Nursing Research Topics
  • Research Paper Writing Tips

Best Nursing Research Topics for Students

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

  • Select nursing topics for research
  • Conduct effective research
  • Analyze published academic literature
  • Format and cite sources
  • Synthesize data
  • Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

  • Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
  • Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
  • Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

  • Assess the impact of nurse-led diabetes education in Type II Diabetics.
  • Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

  • Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
  • Identify methods that best prepare pre-licensure students for clinical practice.
  • Investigate factors that influence nurses to pursue advanced degrees.
  • Evaluate education methods that enhance cultural competence among nurses.
  • Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

  • Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
  • Assess the effectiveness of mental health education among emergency room nurses .
  • Explore de-escalation techniques that result in improved patient outcomes.
  • Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

  • Assess the impact of parental involvement in pediatric asthma treatment adherence.
  • Explore challenges related to chronic illness management in pediatric patients.
  • Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

  • Analyze the effects of short staffing on nurse burnout .
  • Evaluate factors that facilitate resiliency among nursing professionals.
  • Examine predictors of nurse dissatisfaction and burnout.
  • Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Education in Obstetrics and Gynecological Surgery in 2023

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About this Research Topic

In the last years, the increasing interests in simulation and training in obstetrics and gynecology gain relevant space in the scientific panorama. The reason should be found principally on the technological innovation of training platforms as simulators, pelvic trainers, ext., and the evolution of resident’s training programs with the aim to obtain basic skills in surgery. Thanks to the rigorous policy on training quality made by some countries, a training logbook has been established to certify the real knowledge of every resident. The residents’ surgical level worldwide is very different depending on personal ability or inclination to surgery or different facilities offered by different centers. The training methodology in surgery is a topic under development and it was investigated from different points of view from the technology to the organization methods. This research topic is aimed to collect all the article available focused on last findings, information and novel data on education training in obstetrics and gynecology.

Keywords : Education, Obstetrics and Gynecological Surgery, Mentoring, Training Methodology, Skills Training

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Manipal College of Nursing, Manipal Theses and Dissertations

Theses/dissertations from 2021 2021.

Effectiveness of Comprehensive Hemophilia Education Program (CHEP) on health related Quality of Life and Clinical outcomes of children and young people with hemophilia in selected hemophila clinics of Karnataka. , Anjalin D’Souza

Effectiveness of a Preterm Home Care Program (PHCP) on parent infant interaction among mothers of preterms and the developmental outcomes of the preterms in Kasturba Hospital, Manipal Karnataka. , E. Binu Margaret

A study on Child Abuse, and its relationship with the attitude of adults and Socio – Demographic variables in Udupi Dist. , Sangeetha Priyadarshini

Effectiveness of Developmental Supportive Care Program (DSCP) on the health status of preterm infants, knowledge, and practice of care providers in a selected Neonatal unit of tertiary care hospital. , Yashoda Sathish

Theses/Dissertations from 2020 2020

“ Life Style Factors Associated With Elevated Blood Pressure Among Working Women Of Selected Institutions Of Udupi Taluk: A Case Control Study.” , PRIYA LAVEENA ALVA

Prevalance, Risk factors for Malnutrition and effectiveness of need-based intervention on nutritional status and cognitive development of preschool children in Anganwadi centers of Udupi Dist. , Ansuya .

Effectiveness of a comprehensive educational program for Accredited Social Health Activist (ASHAs) to identify individuals with bleeding disorders in udupi District: A community –based study , Sulochana B

“A study to assess the knowledge on post Exposure prophylaxis and adherence to Needle stick injury prevention measures among nurses in selected hospitals of Udupi taluk, Karnataka” , KUSUMAVATHI .

" “A Study to Assess the Pattern of Smartphone Usage, Smartphone Addiction and Associated Subjective Health Problems Among Nursing Students of Selected Colleges of Udupi District” " , JOYCE MACHADO

“A Study to Assess The perception towards Tobacco Consumption And Its Usage Among The Auto Rickshaw Drivers Of Udupi District, Karnataka” , SHAKEEL MOHAN

"“A cross-sectional study to assess the body Mechanics, perceived musculoskeletal problems and health-seeking behaviour among Construction workers of Udupi district.” " , RAGHAVENDRA NAYAK

Oral Care Protocol for Chemotherapy and Radiation therapy included oral complications in Cancer Patients. , Radhika R Pai

“A Comparative Study To Assess The Attitude And Self-Reported Practices Of Self- Medication Among The Healthcare And Non- Healthcare Undergraduate Students Of Selected Institutions Of A University In Udupi District, Karnataka” , ILAKKIYA P

"“A descriptive study to assess the Knowledge and attitude towards global Warming and perceived impacts of Regional climate change on health among the health science students of Udupi District, Karnataka” " , BADAPLIN RYNJAH

“A Study To Assess The Correlation Between Level Of Critical Thinking Ability And Competency In Performing Neurological Assessment Among Nursing Students Of Selected Nursing Colleges Of Udupi District, Karnataka” , PIYALI SAHA

“Awareness about rights of older adults, attitude and perception towards ageism among the college students of Udupi district: A descriptive cross-sectional study” , ANGEL THOMAS

Theses/Dissertations from 2019 2019

A study to assess the knowledge regarding endometriosis and wellbeing of women diagnosed with endometriosis in selected hospitals of Udupi Taluk, Karnataka , ANNIE NIRMALA A

“Effect of Mandala Art Therapy on attention and functional social skill among intellectually disabled children in a selected special school of Udupi, Karnataka.” , POOJA BAKSHI

A study to assess the symptoms of Irritable Bowel Syndrome (IBS), dietary habits and stress among employees working in selected institutes of Udupi district, Karnataka , SANGEETA BSR

Effectiveness of Pulmonary Interventions (PI) on Health-Related Quality Of Life (HRQL) and Clinical Outcomes (CO) among Chronic Obstructive Pulmonary Disease (COPD) patients. , Flavia Castelino

Effectiveness of E-Surveillance by the Infection Control Competent Nurses (ICCN) in selected hospitals of Udupi and DK Dist. Karnataka , Soumya Christabel

A comparative study to assess the life satisfaction, self-esteem, depression and health related behaviour among pensioners and non- pensioners elderly population of selected villages of Udupi taluk, Karnataka , ROSHINI DSOUZA

A case control study to assess the risk factors associated with fetal and neonatal death in Kasturba Hospital (KH), Manipal, Karnataka , RITU KUMARI

Efficacy of Acupressure on contributing factors of fatigue, severity of fatigue, Oxidative Stress Markers (OSM) and other blood parameters of patients with End-Stage Renal Disease (ESRD) on Maintenance Hemodialysis (MHD) in a selected tertiary hospital of Udupi Dist. Karnataka , Daisy Josphine Lobo

A study to assess the post-menopausal symptoms, stress and coping strategies among women in selected villages of Udupi taluk, Karnataka , SOWMYA NAIK

A correlational study to assess the emotional intelligence, self-esteem and assertiveness among youth studying in selected undergraduate higher educational institutions of Udupi district. , JAGRITI NIYOGI

A study to assess the determinants and outcomes of acute kidney injury among patients admitted to critical care units of a tertiary care hospital of Udupi district , CAROLINE LIYAN NORONHA

A retrospective survey on clinic epidemiological profile of venomous snake bite patients in Kasturba Hospital, Manipal , TANUSREE PRADHAN

A descriptive study to assess non suicidal self-injury (NSSI) behaviour and emotional dysregulation among college students of selected colleges in Udupi district, Karnataka , MANISHA SAMANTA

A study to assess the functional abilities and quality of life (QOL) among the adult patients with hearing loss and their perspective towards use of hearing aid in selected hospitals of Udupi district, Karnataka , SHALINI .

A study to assess the awareness and attitude on gamete donation in Kasturba Hospital, Manipal, Udupi district, Karnataka in a view of developing a information booklet , HEMA SHANKAR

A retrospective cohort study on perinatal outcomes of hypertensive disorders of pregnancy among women hospitalized to a tertiary referral hospital of Udupi Taluk, Karnataka , BINITA SHARMA

A study to assess information needs and risk of venous thromboembolism in cancer patients receiving chemotherapy with a view to develop and validate an information guide in a tertiary care centre, Udupi district , SMITA D VARGHESE

Multidimensional Intervention on Self-Management and Quality of Life of type 2 Diabetes patients , Aldrin Vas

Theses/Dissertations from 2018 2018

A study to assess the peer influence and the behavior among adolescents of pre-university colleges of Udupi taluk , JISHA MARY ALEXANDER

A descriptive study to assess the knowledge and perception regarding menopause among married women and their spouses in selected villages of Udupi Districts. , AMITHA .

A descriptive study to assess treatment nonadherence among people diagnosed with stroke and burden among their caregivers in Kasturba Hospital Manipal , ASHWINI .

A descriptive study to assess the prevalence of stress urinary incontinence among middle aged women who are working under MIS in selected institutions of Manipal Academy of Higher Education in view of providing health teaching on pelvic floor exercise. , LIBY BABY

A retrospective study to assess the prevalence, determinants and outcome of sepsis in a tertiary care hospital, Udupi district. , DRAGO MELBA BAZEL

A correlational study on physical activity, energy expenditure and body weight among secondary school children in selected schools of Udupi district, Karnataka. , KALYANI BISWAS

A study to assess the pain level of the critically ill patients admitted in ICUs and the nurse’s perception on pain of critically ill patients in selected tertiary care hospital, Udupi district. , CHHANDA CHAKRABORTY

A Randomized Controlled Trial to Evaluate the Impact of Nurse Navigator Programme (NNP) on Anxiety, Psychological Distress and Quality of Life of Breast Cancer Patients in a Tertiary Care Hospital, Karnataka” , Shejila C H

A study to assess the health literacy and barriers to health literacy among health sciences and non-health science members of selected institutes of Udupi district, Karnataka. , FELCITA LAVINA CUTHINO

A study to assess the knowledge on stroke and health seeking behaviour among hypertensive patients in selected tertiary care hospital, Udupi district, Karnataka. , DIVYA DAVIS

A study to compare the quality of life, child adjustment and social support of only child and child with siblings in selected schools of Udupi district. , ARLINE TENCY DSOUZA

A descriptive study to assess the knowledge on mental health and mental illness among students of selected health professional colleges of Manipal Academy of Higher Education, Manipal, Udupi district. , HENSHAW NSA EKANEM

A case control study to compare the factors influencing early onset of menarche among school children in selected schools of Udupi district. , JESNA JOSEPH

A study to assess the effectiveness of nutritional enhancement programme on knowledge and micronutrient deficiency assessment skills among mothers of anganwadi children and dietary intake of micronutrients of anganwadi children in selected anganwadi centres of Udupi district, Karnataka. , SHRADDHA S KANCHAN

A Comparative study to determine The effectiveness of Antepartum breathing exercises on outcome of labor between Primigravid and Multigravid Women in selected hospital Of Udupi District, Karnataka , Sushmitha Ramona Karkada

A study to assess the effectiveness of Prenatal Training Module (PTM) on knowledge and skill of newborn care among mothers in the selected Hospitals of Udupi District. , KAVYA .

A study to assess the awareness of Gestational diabetes mellitus and identify compliance to management among Gestational Diabetes mellitus in selected hospital of Manipal Academy of Higher Education, Udupi District, Karnataka. , MEENA KONSAM

A case- control study to assess the knowledge and risk factors of urolithiasis among patients attending urology outpatient department (OPD) in selected hospital of Udupi district, Karnataka. , MERLIN K KUNJUMON

A study to assess the effectiveness of mindfulness meditation on anxiety and sleeping pattern among the nursing students in selected nursing colleges of udupi district" , UMA LAMICHANEY

A study to assess the knowledge of type II diabetes mellitus patients on diabetic neuropathy and to identify the people at risk for the development of upper extremity diabetic neuropathy among type II diabetes mellitus patients with a view to develop an information pamphlet in a selected hospital of Udupi district, Karnataka. , CLARITA SHYNAL MARTIS

A study to assess the effectiveness of an educational intervention on knowledge and practice of peripheral intravenous catheterization by healthcare professionals (Nurses) among neonates of NICU’s in selected hospitals of Udupi district, Karnataka. , JIJI MATHEW

A comparative study to assess the Health Related Quality of Life (HRQoL) and perception of body image among normal and overweight/obese adolescents in selected English Medium Schools of Udupi District, Karnataka. , JANE JYOTHI MATHIAS

A case control study to identify the biopsychosocial risk factors that may contribute to intellectual disability among children attending selected special school of Udupi district, Karnataka. , HENITA JOSHNA MENEZES

A descriptive study to assess the symptoms and risk factors of carpal tunnel syndrome among the computer users in selected workplaces of Udupi district, Karnataka , KEERTHI NAIK

A study to assess the depressive symptoms and bio-psychosocial problems among postmenopausal women living in selected villages of Udupi district, Karnataka , SHWETHA NAYAK

A study to assess the effectiveness of an educational intervention on knowledge and practice of staff nurses on prevention of Ventilator Associated Pneumonia (VAP) in neonates of a selected Neonatal Intensive Care Unit of a tertiary care hospital. , DIPANJALI ROY

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This article has been retracted.

Analysis of obstetric clinical nursing integrating situational teaching simulation, shanshan xiao.

The Affiliated Hospital of Medical School, Ningbo University, Ningbo 315020, China

Xiaoxiao Zhao

Hongyan tang, yuanping wang, associated data.

The labeled dataset used to support the findings of this study are available from the corresponding author upon request.

This paper applies the situational teaching mode to obstetric clinical nursing. When explaining the nursing operation skills, according to the pre written script, design some common clinical nurse-patient conflicts and carry out situational simulation performances, so as to inspire students to think about how to effectively communicate with patients and their families and establish a harmonious nurse-patient relationship. At the same time, this paper also urges students to improve their initiative of autonomous learning and actively participate in the whole process of learning, rather than passively accept knowledge. Finally, the teaching methods of combining obstetric clinical nursing teaching with experimental teaching were compared to explore the effectiveness of situational teaching simulation teaching mode. Through the experimental comparative analysis, it can be seen that the obstetric clinical nursing teaching model based on situational teaching simulation has a certain effect and has a good guiding significance for the practical teaching of obstetric clinical nursing.

1. Introduction

Scenario-based teaching refers to a teaching method in which teachers create a realistic teaching situation with the support of relevant technical conditions according to the requirements of teaching objectives, so that students can play roles in an environment close to the real situation, and learn relevant knowledge and skills from it. The nursing teaching of obstetrics and gynecology in secondary vocational education is a practical course. Students need to master proficient operating skills and be familiar with various practical problems during the study period, so that they can be handy in the future nursing work in obstetrics and gynecology, deal with various problems calmly, and improve patients' satisfaction with nursing. Therefore, the teaching of obstetrics and gynecology should actively introduce the situational teaching method to fully demonstrate the dominant position of students.

At present, with the wide application of information technology, the nursing teaching of secondary vocational obstetrics and gynecology has made new progress. Teachers use the support of multimedia technology in the classroom, which can make the teaching content richer and more vivid, which is convenient for students to extensively study practical cases, and then guide their own professional skills training. However, the nursing work of obstetrics and gynecology contains many contents, even very trivial. In the treatment of gynecological diseases and maternal care, students need to have strong practical ability to provide effective nursing and help to patients. Therefore, the nursing course of obstetrics and gynecology has the characteristics of large amount of knowledge and abstract content, and the existing teaching work still has certain shortcomings.

The purpose of scenario teaching is to stimulate students' enthusiasm and initiative. Therefore, after selecting and creating scenarios, teachers should further set up specific tasks and problems to give students the opportunity to learn independently. Teachers can divide the students in the class into several groups and then introduce problems that need to be considered and dealt with in various situations and then discussed by the group members. The members of the group have both division of labor and cooperation, and they jointly apply the relevant knowledge points of obstetrics and gynecology nursing, break through difficulties, and propose solutions, so as to realize the integration of theory and practice. For example, after collecting and examining the medical history of obstetrics and gynecology patients, how to formulate nursing measures according to different cases and the issues that should be paid attention to in the nursing work after natural childbirth, etc. can be used as topics for students to think about. Moreover, students draw and practice through simulation, and finally, the group representatives make a summary and share the results in the class. Through the analysis of different case scenarios, the team members communicated nursing plans, which not only realized mutual learning but also facilitated familiarity with more practical scenarios.

In order to improve the clinical nursing effect of obstetrics, this paper applies situational teaching to the clinical nursing research teaching of obstetrics, improves the teaching effect of obstetrics nursing, and promotes the nursing effect of hospital obstetrics.

2. Related Work

The situational teaching method dilutes the traditional teacher's “preaching” color, gives students more classroom practice, stimulates students' interest in learning, and creates a good classroom learning atmosphere. The situational teaching method changes students' passive acceptance state, encourages students to actively participate in teaching activities, and promotes abstraction. The specific theoretical knowledge can effectively make up for the shortcomings of traditional “cramming” teaching and optimize the teaching effect of obstetrics and gynecology nursing. In the simulation situation, students play a certain role in it, actively participate in practical activities, think and explain according to learning theory, and give students more opportunities to express and think [ 1 ]. Actively participating in classroom learning activities is conducive to improving the enthusiasm of classroom teaching, improving the openness of teaching, and enabling students to better grasp the knowledge of obstetrics and gynecology nursing [ 2 ].

In the process of situational teaching, the use of situational interaction can promote teachers and students to communicate on an equal footing. At the same time, teachers can also guide students to express their personal opinions, so that students can analyze and solve problems, put forward personal opinions, and improve students' innovative ability. The situational teaching mode breaks the traditional teaching mode, combines theory with practice, cultivates students' autonomous learning ability, urges students to deeply understand relevant theories, realizes entertaining, pays more attention to the cultivation of patients' true feelings, and improves the communication skills between nurses and patients [ 3 ]. Actual situational teaching can provide students with more opportunities for practical exercise and encourage students to combine the professional knowledge of obstetrics and gynecology nursing and related knowledge and use the simulation environment to encourage students to realize empathy and train their professional quality and thinking. Moral quality, psychological quality, and body speed, promote self-education and, at the same time, promote better development of students, realize division of labor and mutual learning through situational demonstrations, cultivate students' spirit of unity and cooperation, improve students' work ability, and lay a good foundation for students' future development. [ 4 ]. Therefore, the situational teaching mode is an open teaching mode, which is conducive to cultivating students' various abilities and meeting the requirements of cultivating high-quality applied talents [ 5 ].

During the situational teaching, students analyze and discuss nursing error cases, so that students can realize that once mistakes occur in the work, nursing errors may occur and then cultivate students to enrich medical theoretical knowledge and serious and responsible attitude, cultivate students' prudent and independent spirit, and avoid occurrences as much as possible. With the popularization and development of hospital nursing systemization, the teaching focus has shifted to realize the integration of nursing teaching [ 6 ]. In the process of obstetrics and gynecology nursing training, doctors and nurses can be combined with clinical teaching, and theoretical learning and practice can be combined, which can promote strengths and avoid weaknesses, transform medical knowledge and nursing theory into practice, and promote students to better observe and analyze conditions, shorten the distance between theory and practice as much as possible, consolidate classroom knowledge, better understand and master nursing procedures and really apply them to practice, improve students' nursing level, and lay a good foundation for students' clinical practice and practical work [ 7 ].

During scenario teaching, teachers can guide students to analyze specific scenarios with the help of basic theories and then be able to identify problems, analyze problems, and choose the best solution. The combination of basic theory and specific practice can cultivate students' ability to integrate theory with practice, realize application of what they have learned, and cultivate students' clinical practice. It can change the current disconnection between knowledge and action and improve students' problem analysis ability and problem solving ability [ 8 ]. The situational teaching mode changes the traditional single teaching method, respects the dominant position of students in the classroom, realizes the bilateral interaction between teachers and students, and improves the teaching quality of obstetrics and gynecology nursing. It can optimize the effect of classroom teaching, promote bilateral interaction between teachers and students, and gradually cultivate students' clinical thinking. The situational teaching mode is more vivid, intuitive, and vivid, which enables students to carry out practical exercises more concretely and deeply, gives students a better emotional experience, cultivates students' active learning attitude, and improves the teaching effect of obstetrics and gynecology nursing [ 9 ]. In the traditional teaching process, teachers pay more attention to the diagnosis and treatment of obstetrics and gynecology diseases of students, but they do not pay enough attention to cultivating students' comprehensive quality and overall nursing concept, which prevents students from effectively grasping the overall nursing effect [ 10 ]. From the current point of view, the overall nursing application in the teaching of obstetrics and gynecology nursing is not very ideal and thus cannot meet the requirements of clinical nursing and health care. Reforming teaching methods is conducive to cultivating more practical talents, improving students' business ability and professional ability, and improving the overall quality of nursing [ 11 ]. As a teaching practice and a feasible and effective teaching method, the situational teaching mode breaks through the traditional teaching mode, makes up for the shortcomings of pure knowledge imparting, promotes emotional resonance between teachers and students, and then stimulates students' interest in learning and improves the teaching of obstetrics and gynecology nursing. It can cultivate more practical and high-quality nursing talents [ 12 ].

3. Research Method

3.1. test preparation.

We randomly select the students into groups and divided them into the experimental group and the control group. There is no significant difference in the medical education background of the two groups of students, and they were comparable. The theoretical and experimental teaching of the two groups of students is all completed by the researchers themselves, and the teaching syllabus, teaching plan, number of hours, teaching objectives, and teaching progress are all the same. In the teaching of the experimental group, some experimental courses are selected to be taught by the PBL-scenario simulation teaching method, and the teaching of the control group is taught by the traditional teaching method.

The PBL teaching method adopts a problem-based teaching method, and the design and compilation of medical records is the core of the whole teaching. The design and compilation of medical records should be based on the undergraduate syllabus and teaching objectives, covering the teaching content of the taught courses, with prominent key points and difficulties, and students should be able to find enough relevant materials and reference books or learning websites for autonomous learning. The medical records are sufficiently representative, inspiring, and exploratory. The design of medical records should be clear in diagnosis and moderate in difficulty and in line with the cognitive characteristics and level of students in school and can be grasped and understood by students. When compiling PBL medical records, the teacher designs and compiles the cases according to the selected nursing operation techniques [ 13 ]. After forming the preliminary cases, the teachers of the teaching and research department will design and discuss in detail whether the various manifestations of the cases and the auxiliary examination conditions are true and complete when the teaching and research room meetings are held. Finally, in order to make the cases more standardized, systematic, and more in line with the actual clinical situation, after the preparation of the medical records, the cases are handed over to the teachers of the obstetrics and gynecology department of the internship hospital for discussion and revision in the department, and the final SC is formed. After the writing of SC is completed, it is rewritten according to the experimental content, and it is divided into student version and teacher version. In the case of the student version, there is a brief introduction of the medical history and a small number of physical examination results, which only serve to introduce the case and inspire students to think. The teacher's version of the case contains comprehensive medical history, physical examination, and laboratory test results, which are used for teachers to guide students' thinking.

For students, PBL situational simulation teaching is a brand-new teaching mode. Before this study, all students had never been exposed to this teaching method. Before teaching, students should give a brief introduction to the PBL scenario simulation teaching method. At the same time, it is necessary to do a good job of mobilizing students' thoughts, so that students have the necessary understanding of this teaching method and sufficient psychological preparation to accept a new teaching method. In addition, it is necessary to inform students that PBL teaching is a teaching method of “teacher-led, student-based, and case-based.” The five-stage teaching process is applied in PBL teaching, namely, teachers raise questions, and students establish hypotheses, collect data, demonstrate hypotheses, and summarize [ 14 ]. In PBL teaching, only by thinking independently and independently can we acquire knowledge and solve problems. A situational teaching method means that in the process of teaching, teachers purposefully design or introduce realistic clinical scenarios, so that students can be immersed in the situation, arouse students' emotional experience, stimulate students to think actively, and finally inspire students to understand knowledge, analyze problems, deal with emergencies, and communicate and coordinate. Moreover, situational teaching emphasizes placing learning in a real situation, so that students can have real experience and solve real problems.

After the SC preparation is completed, according to the characteristics of the case and the development process of the disease, a scenario simulation script is prepared. First of all, according to the needs of the development of the plot, the characters to appear are generally composed of 1 nurse, 1 patient, and 1.2 family members of the patient. Secondly, it is necessary to discuss the writing of the script with the nurse-patient communication teacher, set the nurse-patient conflict in the experiment, and write the script. For example, in scene 1, because of lack of medical knowledge, a woman with episiotomy who refused to perform genital scrubbing operation had some language conflicts with the nurse and refused to continue treatment. In scenario 2, there is a lack of breastfeeding knowledge, and there is difficulty in breastfeeding, and the mother and family members who are ready to choose supplementary feeding. In scene 3, the patient is faced with arrears and withdrawal of medication, the family members are waiting in the corridor for the patient to undergo vaginal lavage treatment, and the anxious family members speak rudely to the nursing staff and other common conflicts. Finally, after the playbook is finalized, teachers guide students to memorize and recite lines and guide and correct students' performances [ 15 ]. In order to avoid the students' performances being too exaggerated, false, and the traces of the performances too heavy, it is necessary to make all the students' attention focus on the performance itself, so as to avoid ignoring the solution of the problem and fail to achieve the purpose of promoting students' critical thinking. At the same time, the test site needs to be prepared according to the experimental requirements. The test site is set up in the classroom of the nursing department, and the simulated hospital bed is set up in the classroom.

As a new open teaching method, PBL-scenario simulation teaching method has higher requirements on teachers' own professional quality, classroom regulation ability, teaching skills, language communication ability, and so on. This teaching method not only requires teachers to be proficient and thorough in the content of this major and the course but also requires teachers to master a lot of knowledge of related disciplines and have the ability to ask and solve problems, the ability to use knowledge flexibly, more rigorous logical thinking, and good organizational skills and to be able to mobilize students' enthusiasm, achieve entertaining, and control the rhythm of the classroom [ 16 ]. Therefore, when teaching PBL-scenario simulation teaching method, teachers need to learn and read a large number of PBL and situational simulation teaching materials and be proficient in the PBL-scenario simulation teaching method. Before teaching, teachers should prepare lessons carefully, write medical records, and be familiar with the contents of cases and related knowledge of anatomy, physiology, and pathology. At the same time, it is also necessary to have rich clinical experience and communication skills and to be able to cope with the occurrence of emergencies, all of which put forward very high requirements for teachers.

3.2. Implementation of Scenario Simulation Teaching

In the first stage (20 minutes after the theory class), the problem is raised, and the division of labor is arranged. This stage is not completed in the experimental class, but in 20 minutes after the theoretical class, 3-5 days before the first experimental class, the teacher distributes the SC to the students, finds a student to read the SC aloud in the class, and guides the students to familiarize themselves with the case, so as to ensure that there are no questions that the students cannot understand in the case. After that, we need to select the leader of the group discussion and arrange for the leader to lead the students to have an after-class discussion and ask interesting learning questions. At the same time, it is necessary to decompose, classify, and arrange the problems raised to ensure that each student in the group has a problem that needs to be solved. Finally, the reference books and websites that students use to solve problems are given to ensure that students can get enough help and expand their learning space and time. In the second stage (the first experimental class), there are class discussion and problem-solving stage. This stage is completed in the experimental classroom, and the patient and the patient's family will tell the medical history process according to the lines written in advance. After listening to the narration of the medical history, the group members will discuss and share the materials they have collected with the group members and use the brainstorming method. After that, students need to be encouraged to put forward as many assumptions and questions as possible and then question these assumptions and questions one by one. At the same time, there needs to be an in-group discussion, the secretary records the feedback information, and then the students discuss further to solve the problem. After a large amount of data collection, information aggregation, and layer-by-layer analysis and after removing the false and keeping the truth, a summary is made, the most appropriate treatment method is found, and the students are guided to analyze the nursing operation skills most needed by the patients and lead to the experimental teaching content of the next class. At the same time, the teacher assigns the teaching tasks of the next experimental class to the students, shows the conflict script to the students, guides the students to discuss after class, and analyzes the method to resolve the conflict. In phase 3 (second lab session), questions left over from the previous session are discussed to ensure there are no more unresolved issues. After that, the teacher taught nursing operation techniques. During the process of the teacher's narration and teaching, the students who played the patient and their family members performed according to the script written in advance, forming a conflict between nurses and patients. At this time, it is necessary to guide students to use the knowledge of nurse-patient communication that they have learned to analyze and resolve the conflict between nurses and patients and form a summary after class discussion. Finally, it is necessary to guide students to practice experimental operation techniques in groups and require students to master the experimental operation steps. Before getting out of class, the teacher assigns homework and asks each student to organize the knowledge gained from self-learning into documents, send them to the public mailbox to report and exchange, and solve problems together through the sharing of information and experience. At the same time, the teacher summarizes the key points and difficulties of the teaching and gives feedback and evaluation of the teaching activities to give positive encouragement to students, affirm students' spirit of exploration and active learning performance, and give objective evaluations at the same time.

In the first experimental class, it is necessary to teach the experiment according to the requirements of the experimental outline, follow the experimental operation guidance steps, and tell the students about the experimental purpose, operation materials, experimental steps, and experimental precautions. At the same time, it is necessary to play the recorded experimental operation video and teach it and then guide the students to practice in groups and the teacher to patrol. In the second experimental class, it is necessary to point out the common mistakes and deficiencies of the students in the first experimental class and guide the students to practice in groups, and the teachers will inspect and help the students to correct the problems in time. Before the end of the experimental class, the teacher summarizes the steps that students are prone to make mistakes in operation and gives emphasis and guidance [ 17 ].

3.3. Data Collection

After the two experiments are completed, a questionnaire was distributed to investigate the teaching effect of the two experimental teaching methods. In order to ensure the effectiveness and fairness of the assessment, the distribution and recovery of the questionnaires are independently completed by the researchers themselves.

After the data was collected and sorted, SPSS13.0 software was used for statistical analysis and processing. In general, descriptive statistical analysis and chi-square test are used for analysis. For students' theoretical test scores, experimental assessment scores, experimental teaching method teaching effect investigation, critical thinking ability measurement, and medical students' communication skills and attitude measurement, normality analysis of the data is carried out first. The data are normally distributed and are further tested by a t -test.

The scores of nurse-patient communication and experimental operation skills all showed a normal distribution. The data are then subjected to descriptive statistics and independent samples t -test, and the results show that the students in the experimental group have higher test scores than the control group, and the difference is statistically significant. The test results are shown in Tables ​ Tables1 1 ​ 1 – 3 . The corresponding statistical chart is shown in Figures ​ Figures1 1 ​ 1 – 3 .

An external file that holds a picture, illustration, etc.
Object name is CMMM2022-6843196.001.jpg

Comparison of total test scores.

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Object name is CMMM2022-6843196.002.jpg

Comparison of nurse-patient communication scores.

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Object name is CMMM2022-6843196.003.jpg

Comparison of experimental operation skills scores.

After the test results come out, the scores are input into SPSS13.0, and a single-sample normality analysis is carried out, which shows that the test scores are normally distributed. Then descriptive statistics and independent samples t -test are performed, and the analysis results show that there is no statistically significant difference in theoretical scores between the experimental group and the control group, as shown in Table 4 below. The corresponding statistical chart is shown in Figure 4 .

An external file that holds a picture, illustration, etc.
Object name is CMMM2022-6843196.004.jpg

Comparison of the theoretical test scores of the two groups of students.

The comparison of critical thinking is shown in Tables ​ Tables5 5 ​ 5 ​ ​ ​ ​ – 11 . The corresponding statistical chart is shown in Figures ​ Figures5 5 ​ 5 ​ ​ ​ ​ – 11 . Descriptive statistics and independent samples t -test are performed on the scores of the students in the two groups. The results show that the total score of the CTDI-CV scale of the students in the experimental group is higher than that in the control group, and the difference is statistically significant.

An external file that holds a picture, illustration, etc.
Object name is CMMM2022-6843196.005.jpg

Comparison of the ability to find the truth.

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Object name is CMMM2022-6843196.006.jpg

Comparison of open minds.

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Object name is CMMM2022-6843196.007.jpg

Comparison of analytical capabilities.

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Object name is CMMM2022-6843196.008.jpg

Comparison of systematic capabilities.

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Comparison of self-confidence in critical thinking.

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Object name is CMMM2022-6843196.010.jpg

Comparison of intellectual curiosity.

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Object name is CMMM2022-6843196.011.jpg

Comparison of cognitive maturity.

5. Analysis and Discussion

After reforming the traditional experimental course teaching, this research has preliminarily constructed the PBL-scenario simulation combined teaching method and applied it in the teaching of the experimental course of obstetrics and gynecology nursing. This teaching method combines PBL teaching with situational simulation teaching method. In the experiment, the teacher first gave the students SC and guides the students to study in groups, discuss, look up materials, analyze cases, and analyze layer by layer. In addition, teachers make students find the most appropriate treatment method and select patients who need nursing operation skills most. In the explanation of nursing operation techniques, according to the prewritten script, a situational simulation performance is performed, and some common clinical nurse-patient conflicts are designed to inspire students to think about how to communicate effectively with patients and their families and establish a harmonious nurse-patient relationship. Moreover, every link in the teaching process reflects the principle of “students as the main body, teachers as the main body, and cases as the main line.” It urges students to improve the initiative of self-learning and actively participate in the whole process of learning, instead of passively accepting knowledge.

Obstetrics and Gynecology Nursing, as the main clinical course of nursing, is offered in the sixth semester, which is the last semester for students to study at the school. At this point, students have learned all the basic medical courses and most of the clinical medical courses, laid a good medical foundation and self-learning ability, and formed a preliminary medical analysis ability. This enables PBL-scenario-simulation combined teaching to be opened and welcomed by students.

Acknowledgments

This work was supported by the Affiliated Hospital of Medical School, Ningbo University.

Data Availability

Conflicts of interest.

The authors declare no competing interests.

  • Open access
  • Published: 03 April 2024

The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis

  • Olga María Luque-Alcaraz   ORCID: orcid.org/0000-0003-1598-1422 1 , 2 , 3 , 5 ,
  • Pilar Aparicio-Martínez   ORCID: orcid.org/0000-0002-2940-8697 3 , 4 ,
  • Antonio Gomera   ORCID: orcid.org/0000-0003-0603-3017 2 &
  • Manuel Vaquero-Abellán   ORCID: orcid.org/0000-0002-0602-317X 2 , 3 , 4  

BMC Nursing volume  23 , Article number:  229 ( 2024 ) Cite this article

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People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses’ environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices.

To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment.

A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain.

Most of the surveyed nurses ( N  = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions ( p  < 0.05). Additionally, the adjusted model indicated that nurses’ environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge ( p  < 0.01). The results of the qualitative study ( N  = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved.

Conclusions

This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.

Graphical Abstract

nursing research topics related to obg

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Introduction

The impact of climate change on human society is a global concern, especially with regard to microplastics, resource shortages, air pollution, droughts, and extreme weather. Such consequences affect human health both directly and indirectly, resulting in an increase in pathologies and a deterioration in medical attention [ 1 , 2 ]. In this context, diverse measures aimed at reducing the environmental impact of daily activities and minimizing the ecological footprint thereof [ 3 ] have been implemented by multiple countries [ 4 , 5 , 6 , 7 ]; these activities have been framed as environmental regulations in line with the Sustainable Development Goals (SDGs) [ 8 ].

The SDGs are being integrated into governments and a variety of other contexts, including the health care system. Spain is dedicated to such a goal, i.e., that of promoting a greener and more democratic health care transition. To achieve this goal, strategic plans have been developed to mitigate the effects of climate change [ 9 , 10 ]. One specific such program is the Strategic Health and Environment Plan (PESMA) [ 11 ], whose aim is to enhance the synergy between health and the environment innovatively by assessing the impact of the population in terms of 14 environmental indicators [ 12 ].

One such indicator focuses on the resources and support needed for sustainable practices, especially for nurses, due to the impact of the environment on their work [ 13 , 14 ]. The PESMA highlights the fact that health care providers should be included in strategies to reduce carbon footprints, build resilience to address the challenges associated with climate change and embrace a leadership role in the task of promoting sustainable health care practices [ 13 , 14 , 15 , 16 ]. Another critical aspect of PESMA focuses on education, training, and incentives that can promote sustainable behavior among health care workers, especially nurses [ 17 , 18 ]. As frontline health care workers, nurses have a unique opportunity to advocate for sustainable practices and reduce the environmental impact of the health care system. Nurses’ knowledge and behavior are limited despite the fact that nurses have positive attitudes toward environmental sustainability [ 19 ].

This situation stands in contrast to the role of nurses in the creation of more sustainable hospitals via the “Green Team” [ 20 ]. The Green Team, which originated in the United States of America a decade ago, is a committee that is responsible for finding and implementing sustainability projects to decrease the environmental impacts of daily operations. Members of various departments collaborate with sustainability staff to detect opportunities, spread awareness, and promote staff involvement in line with the Committee’s mission [ 21 ]. The team, which typically consists of and is led by nurses, aims to increase awareness of the health care industry’s effect on the environment and to develop tactics to mitigate the adverse environmental effects of hospitals.

In Spain, Green Teams, which span multiple disciplines and usually led by nursing professionals, are committed to sustainable change in health care [ 22 ]. Environmental nursing leaders on Green Teams control environmental sustainability in health care settings and provide education, resources, and support to other professionals with regard to the implementation of sustainable practices [ 23 ]. Accordingly, all nurses can contribute to the tasks of mitigating the impact of climate change on public health outcomes and promoting sustainable health for all [ 24 ]. These actions improve nurses’ knowledge, attitudes, and behavior in terms of sustainability and promote sustainable practices in health care settings, thus leading to a better understanding of the barriers faced by nurses in this context [ 24 , 25 , 26 ].

However, measuring and identifying nurses’ environmental awareness is essential for the promotion of sustainable hospitals [ 27 , 28 ]. Multidimensional indicators have been proposed for this purpose [ 16 ], the responsibility for which lies with nurse leaders on Green Teams. Nurses are responsible for promoting sustainability in health care organizations, as discussed by Kallio et al. (2018) [ 29 ], as well as for promoting nursing competencies related to environmental sustainability [ 30 ]. Several studies, including Harris et al. (2009) and Phiri et al. (2022), have examined nurses’ roles in environmental health and the effects of their leadership on the promotion of sustainability, especially during the COVID-19 pandemic, thereby emphasizing the importance of leadership [ 31 , 32 ].

As Ojemeni et al. (2019) discussed, leadership effectiveness in Green Teams, nursing teams and health care organizations must prioritize quality control and health care improvement to ensure sustainable development [ 33 ].

The topic of environmental management in health care organizations has been studied extensively, and an environmental or ecological model of care for promoting sustainability has been proposed [ 34 ]. As environmental creators and leaders on Green Teams, nurses are vital for minimizing hazardous waste in health care settings and improving awareness [ 35 ].

Although nurses have some degree of existing knowledge and awareness of sustainability, it is crucial to assess their proficiency in environmental matters and to gauge their environmental awareness. Such an evaluation can help identify areas for improvement within clinical management units [ 20 , 33 , 36 ]. Education and training programs can effectively promote sustainable behavior among nurses, but interventions should also address the barriers they face in their attempts to implement sustainable practices [ 37 ]. Therefore, it is imperative to examine the factors that foster sustainable behavior among nurses and to identify effective interventions that can promote sustainable health care practices and minimize the environmental footprint of health care facilities. Accordingly, this study aimed to analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to creating a sustainable environment.

Study design

A sequential mixed-method study was conducted based on an online survey and interviews with a representative sample of Spanish nurses, including participant observation.

The study was divided into two phases. In the first phase, a cross-sectional, descriptive exploratory analysis was performed; this analysis relied on the results revealed using the Nurse’s Environmental Awareness Tool in Spanish (NEAT-es) [ 38 ], which was divided into three subscales: nursing awareness scale (NAS), environmental behaviors outside the workplace (PEB) and sustainable behaviors in the workplace (NPEB). In the second phase, qualitative interviews with environmental nurses (see Supplementary file 1 ) were conducted in regions featuring specific environmental units that were available in person (Andalusia).

Participants

The participants were recruited from public and private institutions associated with the National Health System, particularly from the nursing staff. The scope of the study focused on Spain, and the sample included all the nursing staff who completed the questionnaire and met the inclusion criteria.

The sampling process focused on the population of nurses in Spain in 2020, which was estimated to consist of 388,153 nurses. Therefore, a random sample of 314 participating individuals was sufficient to estimate the population with 95% confidence and an accuracy of +/- 2% units, which was expected to account for approximately 90% of the overall population. The inclusion and exclusion criteria used for the sample focused on nursing staff, nursing care auxiliary technicians, and students with relevant degrees, as this members of this group have the most significant presence in the health system and engage in direct and daily contact with environmental management in health centers (hospitals, primary care centers, sociosanitary centers and others). The remaining health and nonhealth personnel were excluded.

Additionally, the person from each unit who served as the environmental coordinator and other nurses from the ward who were members of the Green Team were asked to participate in the interviews and observations. The environmental coordinators, most of who were nursing supervisors, were determined based on the number of members of the Green Team and the sampling calculation used for the observational study. The interviews took place after various sessions, talks, or courses pertaining to environmental sustainability at the clinical management units.

Data collection

An intentional sampling process was implemented, and the data collection period spanned from November 2019 to March 2021. The observational data were collected in Spain via messages and posts on social media with the goal of quantifying nurses’ environmental awareness.

The initial sample of qualitative study included five environmental nursing leaders (NLs), 14 registered nurses (RNs), and ten nursing undergraduates. The final sample was reduced when the interviews reached data saturation ( N  = 10, five NLs, and five RNs). Before the interviews, a focal group composed of one nurse, one physician, two engineers and a psychologist was tested using the questions included in this research as part of a pilot study ( Supplementary file 1 ). These interviews were conducted at the beginning of the participant’s shift, usually in the morning, and they featured a median time of 30 min, a minimum of 20 min and a maximum of one hour per participant.

One researcher (O.A.L.) also observed nurses during their daily work after the interview from a position within the ward as an added team member or staff member. Nevertheless, the observer did not highlight mistakes or sustainability issues during the observation process. No other researcher was involved in this step of the ethnographic analysis to avoid bias with regard to observing a variety of tasks ranging from preparing medication to implementing treatments.

The data collected through the interviews were recorded on a Samsung Galaxy 31 A, and observations were collected in a field notebook based on the Google Keep and Evernote mobile applications from November 2019 to mid-March 2021. This study was conducted at a regional level 1 hospital in southern Spain, particularly in various clinical management units (neurosurgery, internal medicine, cardiology, traumatology, and COVID-19 units, among others), and it focused on nursing supervisors, who are the leaders who bear responsibility for environmental awareness (NLs), and registered nurses (RNs) who were members of the Green Team.

Data analysis

The quantitative data were analyzed by reference to descriptive statistics, including the mean, standard deviation (SD), and 95% confidence interval (CI); the relative frequencies of the variables were also analyzed. Normalization tests, Kolmogorov‒Smirnov tests with Lilliefors correction, and Q‒Q tests were used to compare the goodness-of-fit to an average data distribution with regard to continuous or discrete quantitative variables. The comparison of two or three independent means was performed using Student’s t test and analyses of variance for each variable. The Χ 2 test with Yates’ correction was used to compare percentages and Pearson’s correlation (r) coefficients across the quantitative variables. Finally, associations among the NPEB and the other variables were studied through multiple linear regression. Participant observation was used to support the qualitative study of the reflective ethnographic type [ 39 , 40 ], and this process ended when the data reached saturation. Two researchers developed transcripts for the interviews based on the recorded interviews and added descriptions based on the notes from the field notebook. The identification of themes and patrons was based on a process of triangulation among the researchers and by cross-checking the results. The interviews with nurses were analyzed to summarize the content analysis and identify keywords and concurrency among the terms. The themes thus identified included Green Teams, sustainable environmental behaviors, environment awareness, leadership barriers and limitations and areas for improvement.

EPIDAT (version 4.2) and SPSS (version 25) software were used to support the quantitative analysis. The computer program ATLAS.ti (version 22) and the Office Package with Microsoft Word Excel (version 2019) were used for the interviews and the visualization of the keywords based on the themes identified based on the records, observations and field notebooks.

Nurses’ awareness, knowledge, attitudes and skills.

The ages of the Spanish staff, mainly nurses, included in this study ( N  = 314) ranged from 19 to 68, with a mean age of 37.02 ± 12.7, CI = 95%, 35.6–38.4 years); in addition, 76.4% of these participants were women with more than 20 years of working experience (35.1%), and the majority were registered nurses (70.4%). Moreover, 113 (36%) participants worked at a local or regional hospital (30%) and were employees of a public institution (85.3%). Half of the nurses (157) worked only a morning shift (Table  1 ) in Andalusia, Madrid, or Catalonia (62.4%). The diverse autonomous regions on which this research focused were homogenously distributed and structured in line with the population. The analysis of these areas was also based on the specific inclusion of environmental units led by nurses (Andalusia, Madrid, and Catalonia), in contrast with regions featuring undetermined units or leaders related to this topic (such as Valencia) (37.5%).

Regarding nursing awareness, nurses scored higher on the PEB (31.83 ± 8.02 CI 95% 30.94–32.72 with regard to frequency vs. 32.36 ± 7.15 CI 95% 31.57–33.15 with respect to difficulty) than on the NAS (26.13 ± 9.91 CI 95% 25.03–27.23 with regard to knowledge vs. 47.39 ± 5.97 CI 95% 46.73–48.05 with respect to impact) and the NPEB (23.82 ± 6.45 CI 95% 23.10-24.53 with regard to frequency vs. 25.71 ± 6.31 CI 95% 25.01–26.41 with respect to difficulty). These results indicated that environmental knowledge among the Spanish population was limited (55.7%), although the nurses included in this research were aware of their potential impact on the environment (70.4%). The PEB subscale focused mostly on following environmental guidelines in their homes (57.3%) because these sustainable domestic tasks are easier for them (63.1%) than tasks in the professional field. The second subscale, NPEB, indicated that sustainable activities such as recycling were easy for the participants (57.6%), but sometimes they engaged in such activities less frequently than they would like (52.2%) (Fig.  1 and Fig.  2 ).

figure 1

Representation of the frequency of nursing environmental behavior

figure 2

Difficulty of engaging in adequate environmental behaviors

The sociodemographic variables indicated differences among the NEAT subscales (Table  2 ). Gender, working experience (with a median value of 10 years), and the position held in the institution and region were relevant with regard to environmental knowledge ( p  < 0.01), environmental behavior outside the workplace ( p  < 0.01), and environmental behavior in the workplace ( p  < 0.01).

The NPEB was associated with the worst scores, thereby reflecting the nurses’ environmental behavior and activities in the workplace (52.23% rarely performed relevant activities, and 35.03% indicated that doing so was difficult) (Fig.  1 and Fig.  2 ). The NPEB values pertaining to environmental behavior were positively linked to age ( r  = 0.412; p  < 0.001), NAS knowledge ( r  = 0.526; p  < 0.001), PEB frequency ( r  = 0. 57; p  < 0.001), PEB difficulty ( r  = 0.329; p  < 0.001), and finally, difficulty performing adequate environmental behaviors ( r  = 0.499; p  < 0.001). Additionally, the value of the NPEB with regard to the difficulty of performing adequate environmental behaviors was positively associated with age ( r  = 0.149; p  = 0.008), NAS knowledge ( r  = 0.249; p  < 0.001), PEB frequency ( r  = 0. 244; p  < 0.001) and PEB difficulty ( r  = 0.442; p  < 0.001).

Based on the relevance of certain sociodemographic variables, the nurses’ environmental awareness (NAS) and their behavior outside the workplace (PEB), linear multiple regression was performed to investigate nursing behavior in the workplace (NPEB). The initial model (square sum = 488.655; p  < 0.0001) indicated that age, the impact of nursing awareness (NAS), and the frequency of sustainable behaviors outside the workplace (PEB) were not relevant to nursing behavior in the workplace (NPEB) in terms of the frequency of performing adequate behavior or the difficulties experienced ( p  > 0.05). Based on these results, the adjusted model was calculated (Table  3 ), indicating that NPEB depends on PEB frequency and NAS knowledge ( p  < 0.01).

Nursing environmental behavior in the context of Green Teams: Barriers and areas for improvement.

The participants in the qualitative study ( N  = 10) included nine women and one man; their median age was 49 years; they exhibited an interval quartile range of 35–60; they had levels of working experience ranging between 20 and 30 years, and they worked only in the mornings (7/10). Furthermore, the group including nurses and nursing supervisors (5/10) exhibited higher levels of education (see Supplementary file 2 ). The themes identified via repetition and associations during the interviews and observations indicated links among nurses’ responsibilities on the Green Team since they conformed to the nature of such teams (i). This team and nursing leaders identified sustainable environmental behavior (ii) that could improve environmental awareness (iii), knowledge, aptitude, and skills. The nurses who are responsible for sustainable changes should be the leaders (iv), and the relevant barriers and limitations (v) and areas for improvement (vi) in diverse areas should be identified simultaneously.

Green teams were linked to nursing responsibilities in the context of environmental sustainability.

In the interviews, the Green Teams, led by environmental leader nurses and comprising various staff members, were identified as crucial committees dedicated to enhancing environmental awareness and knowledge among hospital staff. Participants indicated that these teams facilitated regular meetings to discuss sustainable practices and played a pivotal role in testing behaviors and knowledge related to environmental sustainability. The Green Teams were highlighted as platforms for fostering collaboration and discussion surrounding sustainable practices. Participants noted that these teams facilitated the main purpose of the team and its members to improve the hospital staff’s knowledge and attitudes via meetings (RN 2,3 and NL 1,3). Subsequently, the NL also indicated a key role of the team in the testing of behaviors and knowledge. The behavior of registered nurses should be tested using questions according to the NLs. Also, the NLs are included in disponibility of of proper disposal methods for medical waste:

“So, where is the rubbish bin for medicines, that white one that you showed in the session that is used for the remains of medicines that we do not give to patients?” [(NL5)]

By such comments, it can be inferred that the Green Team not only disseminates information, manages the training and measures knowledge but also ensures that staff members understand and adhere to best practices in waste management. These tasks of the NLs and other RNs in the Green Team contribute to the overall efficiency and effectiveness of environmental sustainability efforts within the hospital.

Sustainable environmental behaviors were emerged by Green Teams.

The results of the analysis indicated some degree of resistance among the nurses working at the clinical management units with regard to their lack of competencies, especially those pertaining to knowledge, skills and attitudes. The comments from the interviews highlighted potential factors contributing to this resistance, including age-related differences, varying levels of awareness, and challenges in applying the principles of reduce, reuse, and recycle (the three Rs). For instance, one repetitive comment expressed a sentiment of uncertainty, stating “It is what is, but we don’t know it or what to do with it” (RN 3,4,5, and NL 2,3).

“We know what the light packing is, and they (maintenance people) installed it to reduce the lights and reduce the expense and cost, but we don’t know what to do with the rubbish bins” [(NL 4)]

This comment highlights a disconnect between awareness of specific sustainable initiatives and the practical knowledge to implement them effectively. All comments reflect the importance of addressing knowledge gaps and providing practical guidance to support nurses in adopting sustainable environmental behaviours. By acknowledging and addressing these challenges, healthcare facilities can enhance their environmental stewardship efforts and promote a culture of sustainability among staff members.

Environmental awareness were drawn from the nursing responsibilities that led to the creation of the Green Team.

The comments indicated that environmental awareness among nurses was influenced by training sessions and courses on environmental sustainability. After receiving training featuring lectures and courses on environmental sustainability, the leaders also reflected on the ways in which nurses put the recommendations made during the environmental sustainability courses into practice. Moreover, the leaders indicated that education should be beyond formal training sessions. The environmental leaders were interested in supplementing these courses with environmental education practices for the general population, as noted, for example, in reports of discharge from patient care or cycling on the ward. These activities indicated the ideal of including a holistic approach to sustainability within the healthcare setting.

Relevant statements included, “We have to separate residues according to the material… light plastic goes to… it is important for the unit and all of us” (NL 2,5). One key point that the referees and registered nurses highlighted pertained to the climate, particularly the lack of water (NL 1–5 and RN 1,2).

“The drought is getting worse; I don’t know how we are going to keep up… we hope it rains soon” [(RN1)]

Overall, the interviews shed light on the efforts to foster environmental awareness among nurses through formal training and practical integration into everyday practices. These observations emphasize the importance of ongoing education and action in addressing environmental concerns within healthcare settings.

Leadership, which was linked by comments to the Green Teams.

The interviews revealed that leadership, particularly within the context of Green Teams, is crucial in promoting environmental awareness and fostering a culture of sustainability among nursing staff. All the participants ( n  = 10) indicated that the presence of adequate knowledge, meetings and awareness among nursing staff were the most important factors. These factors were identified as key drivers in promoting sustainable practices within the healthcare environment. NLs indicated the importance of creating a supportive working environment where nurses feel comfortable asking questions and seeking clarification without fear of negative feedback. Relevant statements included, “It is key to receive feedback from the nurses and provide a good working environment so that they can ask questions and reflect without negative comments” (NL 1,2,4, and RN 1,2). This working environment allowed the registered nurses to ask for help regarding the three Rs:

“Could you remind me (referring to the environmental coordinator) how the sustainable guidelines were included in the discharge report for the continuity of care; I remember some things from the course you gave us, but I want to convey it completely to my patient” [(RN2)]

Barriers and limitations, were drawn from nurses’ responsibilities.

Several nurses indicated that the difficulties they encountered with regard to performing environmental behaviors pertained to the lack of time, adequate bins, and space as well as the limited number of nurses per patient in the wards. Despite these challenges, participants noted a positive outcome in the form of increased awareness of sustainability issues among nurses, indicating a growing recognition of the importance of environmental stewardship within the healthcare setting. One factor that increased the barriers to environmental adequacy was the pandemic, which increased waste and rubbish. Despite these challenges, participants noted a positive outcome in the form of increased awareness of sustainability issues among nurses, indicating a growing recognition of the importance of environmental stewardship within the healthcare setting. Relevant statements included “There are not enough green rubbish bins for COVID waste” (EL 1,4,5 and RN1,2) and “How are we going to recycle if we don’t even have time to care for patients?” (RN 1,2 and NL 3).

All these comments indicated the barriers the nurses faced, but they also suggested possibilities for improvement. The pandemic, despite overloading nurses, also improved their awareness.

Areas subject to improvement emerged from nursing responsibilities, limitations and leadership.

Nurses indicated that despite their general levels of environmental awareness and the courses they had received, participants performed better regarding their recycling behaviors at home than at the hospital. Participants acknowledged performing better in recycling practices within their personal spaces, suggesting a potential gap in translating theoretical knowledge into practical action within the healthcare environment. Relevant statements included “It’s just that I recycle almost everything in my house, especially glass…, but here, there is no time…” (RN 1,4,5).

Moreover, time constraints emerged as a significant barrier impeding nurses’ ability to engage fully in environmental sustainability efforts. Participants cited the demanding nature of their work, particularly in the context of patient care responsibilities, as limiting their capacity to prioritize sustainability initiatives. This highlights the need for strategies to streamline environmental practices and integrate them seamlessly into nurses’ daily routines without adding undue burden.

Some statements also highlighted nurses’ willingness to improve paperwork and records. Nurses recognized the importance of incorporating environmental considerations into patient discharge reports and other documentation processes but sought further guidance on how to effectively implement these practices. Relevant statements included “Can you tell me how the patient’s continuity care report upon discharge was included in the recommendations for environmental sustainability… I want to do the report well with what you gave us in the clinical session the other day…” [(NL4)]

These comments indicated the opportunities for improvement in fostering a culture of environmental sustainability within the hospital setting. By addressing the identified challenges and providing targeted support and guidance, especially the lack of time, nurses can contribute to environmental stewardship efforts more effectively.

The current research highlights the relevance of nurses as promoters of environmentally sustainable behaviors in their roles as members of Green Teams and important leaders. The findings suggest that nurses exhibit acceptable knowledge, attitudes, and behaviors with regard to environmental sustainability both inside and outside the workplace. These results are complemented by a qualitative analysis indicating that such behaviors originate from nursing responsibility, Green Teams, leadership identification of barriers and areas of improvement. Both analyses highlight the fact that environmental nursing behavior in the workplace depends on sustainable behaviors outside the workplace. The qualitative analysis also identifies diverse barriers to the task of promoting sustainable behavior within the workplace, such as the COVID-19 pandemic and the need for more time to be allocated to this process. One key point identified by both analyses is that nurses have acceptable levels of knowledge; however, their attitudes, although as yet imperfect, are improving.

Several studies of nurses’ awareness of environmental sustainability have revealed that nurses exhibit moderate levels of awareness and a considerable degree of concern regarding the health impacts of climate change [ 37 , 42 , 43 ], as reflected in the NEAT-es results.

Interestingly, the participants exhibited a tendency to perform environmentally sustainable behaviors more consistently in their personal lives than in professional settings. These results are consistent with previous research on registered nurse and nursing students [ 36 , 41 , 42 ]. According to Swedish research, nurses generally recognize environmental issues but may lack awareness of the environmental impact of health care [ 43 ]. Polivka Barbara J. et al. (2012) highlighted the gap between nurses’ knowledge of sustainability and workplace behaviors, thereby emphasizing the need for education and training programs to promote sustainable practices [ 44 ]. These issues were also observed in a study conducted in Taiwan, which revealed that while nursing students exhibit positive attitudes toward sustainability, their knowledge and behaviors are inadequate [ 45 ].

By conducting qualitative analysis, this research also identified multiple barriers to the adoption of sustainable practices among nurses, including time constraints, disruptions caused by the COVID-19 pandemic, a lack of bins, and a lack of health care personnel. These findings are in line with those reported in other research, but certain barriers (in terms of resources, time, and support) to the implementation of sustainable practices in the workplace remain [ 29 ]. This study suggests that interventions should be designed to address these barriers and promote sustainable behavior among nurses, a suggestion which is consistent with the current research. These findings highlight the importance of comprehending nurses’ perspectives on environmental sustainability in health care contexts as well as the necessity for targeted interventions and support mechanisms [ 46 ]. The tasks assigned to nursing leaders and the Green Team involved addressing these barriers and promoting sustainable practices among nurses in the context of their professional roles. Environmental nursing leaders seem to be crucial with regard to establishing a more environmentally conscious health care environment, which is in line with recommendations to create a greener health care system [ 21 , 31 ]. Despite the results of the interviews, some global qualitative studies of nurses’ views on environmental issues have exhibited variations across countries [ 47 , 48 ]. In Sweden, nurses already exhibit pro-sustainability attitudes before the introduction of the 2030 SDGs [ 16 ]. However, the integration of environmental sustainability education into nursing programs can prepare future nurses more effectively to address the challenges associated with climate change and promote sustainable health outcomes [ 49 ].

Limitations

Although this investigation provides valuable insights, it is important to acknowledge its limitations. First, the study was conducted during the COVID-19 pandemic in Spain, which may have influenced the results due to the unique circumstances and stressors faced by health care workers during this period. Additionally, the assessment of nurses’ environmental awareness was performed on a larger scale, i.e., across multiple regions, and therefore may not accurately reflect individual attitudes and behaviors since the qualitative investigations focused on a specific region. However, this approach was adopted to minimize the risk of the ecological fallacy. Future studies could explore individual perspectives and experiences by reference to more diverse and representative samples.

Despite these limitations, this research is highly relevant because it sheds light on the role of nurses in the task of promoting environmental sustainability in health care settings. The research also emphasized the role of nursing leadership in the tasks of promoting environmental sustainability and providing nurses with the necessary resources and support to implement sustainable practices.

In conclusion, while nurses generally exhibit acceptable levels of knowledge, attitudes, and behaviors regarding environmental sustainability, a notable gap persists in terms of the frequency of sustainable actions within the professional settings in which they operate. This finding highlights the importance of closely aligning nurses’ personal and professional sustainability practices.

The qualitative analysis conducted as part of this study identified several barriers to the adoption of sustainable practices among nurses, including time constraints, disruptions resulting from the COVID-19 pandemic, issues with waste disposal, and challenges related to health care personnel. Despite the fact that these findings are in line with those reported in previous research, persistent barriers such as limited resources, time, and support hinder the implementation of sustainable practices in the workplace. Therefore, interventions aimed at addressing these barriers and promoting sustainable behavior among nurses are essential, as highlighted by both current research and the corresponding qualitative insights. Therefore, nursing leaders and Green Teams are pivotal with regard to overcoming these barriers and fostering sustainable practices within health care environments. Environmental nursing leaders in particular are instrumental to the cultivation of a more environmentally conscious health care system, thereby aligning with recommendations for greener health care practices.

Data availability

The datasets used and/or analyzed as part of the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the Excellent Official Nursing School and all the professionals who participated in this research for their support.

This research received no external funding; however, the project did receive an award from the Excellent Official Nursing School in Cordoba, Spain, in 2020.

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A.G. and M. V-A. conceived and designed the study, and O.M. L. and P.A-M. acquired the data, analyzed and interpreted the data, and drafted the article. The publication and supervision of the article were the responsibility of A.G. and M. V-A. All authors contributed equally to the writing and preparation of the final manuscript.

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Ethical approval was obtained from the Ethics Committee of Reina Sofia Hospital of Cordoba, which is part of the Andalusian Health Care System in Spain (Act No. 267, ref.3605). This research was in line with the Organic Law 3/2018 of December 5 on the Protection of Personal Data and Guarantee of Digital Rights as well as the Nursing Ethics Code and the 1964 Declaration of Helsinki. The participants were informed of the study’s purpose before participation; their informed consent was obtained, and they were informed that they were able to withdraw from the study at any stage. All the data were obtained after informed consent was collected; in addition, the data were anonymized and saved securely in a database, thereby maintaining all stipulations of the Personal Data Law.

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Luque-Alcaraz, O.M., Aparicio-Martínez, P., Gomera, A. et al. The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis. BMC Nurs 23 , 229 (2024). https://doi.org/10.1186/s12912-024-01895-z

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  • Environmental health
  • Attitude of health personnel
  • Sustainable development
  • Health Knowledge, attitudes, and practices
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