Audrey Lyndon, PhD, FAAN, RNC, is the assistant dean for clinical research and a professor at NYU Rory Meyers College of Nursing. Her research focuses on safety, communication, and teamwork in maternity and neonatal settings, using the qualitative methods of grounded theory and thematic analysis to examine the perspectives of clinicians and parents on maintaining safety in the perinatal environment. Her team has conducted ground-breaking research developing an understanding of how women and parents conceptualize safety during childbirth and neonatal intensive care. She has also conducted population-based studies of maternal morbidity and has experience with mixed methods approaches. Lyndon is a national leader in perinatal patient safety. She serves on the board of directors at the Association of Women’s Health, Obstetric, and Neonatal Nurses, as a liaison member of the American College of Obstetricians and Gynecologists Committee on Patient Safety and Quality Improvement, and as an associate editor for the Agency for Healthcare Research and Quality Patient Safety Net website. Her clinical experience includes the implementation of quality improvement practices and evidence-based guideline development. The Obstetric Hemorrhage Toolkit, produced by a task force that she co-chaired for the California Maternal Quality Care Collaborative, has been taken up nationally and internationally as a model for collaborative quality improvement. Lyndon is currently a principal investigator for a study investigating relationships between obstetric nursing practice and patient outcomes funded by the Agency for Healthcare Research and Quality.
Prior to joining the faculty at NYU, Lyndon was chair of the Department of Family Health Care Nursing at the University of California, San Francisco, and held the James P. and Marjorie A. Livingston Chair in Nursing Excellence.
Lyndon received a PhD in Nursing Science from the University of California, San Francisco, MS in Nursing with perinatal clinical nurse specialist emphasis from University of California, San Francisco, and a BA in biology and women’s studies from the University of California, Santa Cruz.
PhD - University of California, San FranciscoMS - University of California, San FranciscoBA - University of California, Santa Cruz
American Academy of NursingAmerican College of Obstetricians and Gynecologists (ACOG), Educational AffiliateAmerican Nurses AssociationAssociation of Women’s Health Obstetric and Neonatal NursesInternational Family Nursing Association
Honors and awards
Faculty Honors AwardsReviewer of the Year, Journal of Obstetric, Gynecologic, and Neonatal Nursing (2017)Irving Harris Visiting Professor, University of Illinois, Chicago College of Nursing (2015)Distinguished Professional Service Award, Association of Women's Health, Obstetric and Neonatal Nurses (2013)Fellow, American Academy of Nursing (2012)Award of Excellence in Research, Association of Women's Health, Obstetric and Neonatal Nurses (2011)
Adaptation of the MISSCARE Survey to the Maternity Care SettingAbstractMissed nursing care is an important measure of nursing care quality that is sensitive to nurse staffing and is associated with patient outcomes in medical-surgical and pediatric inpatient settings. Missed nursing care during labor and birth has not been studied, yet childbirth represents the most common reason for hospitalization in the United States. The Missed Nursing Care (MISSCARE) Survey, a measure of medical-surgical nursing quality with substantial evidence for validity and reliability, was adapted to maternity nursing care using data from focus groups of labor nurses, physicians, and new mothers and an online survey of labor nurses. Content validity was evaluated via participant feedback, and exploratory factor analysis was performed to identify the factor structure of the instrument. The modified version, the Perinatal Missed Care Survey, appears to be a feasible and promising instrument with which to evaluate missed nursing care of women during labor and birth in hospitals.
Adherence to the AWHONN Staffing Guidelines as Perceived by Labor NursesAbstractObjective: To evaluate the degree to which registered nurses perceive their labor and delivery units to be adhering to Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. Design: Prospective, cross-sectional study via an online survey of labor nurses recruited from hospitals in three states. Setting/Local Problem: In late 2016 and early 2017, labor nurses in selected hospitals in California, Michigan, and New Jersey were contacted via e-mail invitation to participate in a study about nursing care during labor and birth. Nurse leaders in each hospital facilitated the invitations. Participants: A total of 615 labor nurses from 67 hospitals. Intervention/Measurements: Descriptive statistics and linear regression models were used for data analysis. Results: Most nurses reported that the AWHONN nurse staffing guidelines were frequently or always followed in all aspects of care surveyed. Hospitals with annual birth volumes of 500 to 999 range were significantly more likely than hospitals with 2,500 or more annual births to be perceived as compliant with AWHONN staffing guidelines. Conclusion: When the AWHONN staffing guidelines were first published in 2010, there was concern among some nurse leaders that they would not be adopted into clinical practice, yet nurses in our sample overwhelmingly perceived their hospitals to be guideline compliant. There remains much more work to be done to determine nurse-sensitive outcomes for maternity care and to ensure that all women in labor in the United States are cared for by nurses who are not overburdened or distracted by being assigned more women than can be safely handled. In our survey of 615 labor nurses, most reported that the AWHONN nurse staffing guidelines were frequently or always followed in all aspects of care surveyed.
Failure to Rescue, Communication, and Safety CultureAbstractFailure to rescue refers to the inability to prevent death from health care complications. The fact that more than half of severe maternal morbidity and maternal deaths are classified as preventable, and black women have 2 to 3 times the risk for adjusted severe morbidity and maternal mortality suggest there is a problem with failure to rescue in US maternity care. This article reviews national efforts to improve rescue capacity in maternity care and data on communication breakdowns and disrespect in maternity care, and outlines individual and organizational actions that can be taken to improve communication and rescue processes.
False alarms and overmonitoring: Major factors in alarm fatigue among labor nursesAbstractBackground: Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. Purpose: The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Methods: Nurses were asked via focus groups about the utility of clinical alarms from medical devices. Results: There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Conclusions: Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.
Information and power: Women of color's experiences interacting with health care providers in pregnancy and birthAbstractRATIONALE: Preterm birth and other poor birth outcomes disproportionately affect women of color. Emerging evidence suggests that socially-driven issues such as disrespect, abuse, and discrimination within the health care system influence how people of color experience care during pregnancy, birth, and postpartum, which contributes to poorer outcomes for the mother and baby.OBJECTIVE: As recommended by community partners, we explored how interactions with providers were perceived and understood in the context of seeking care for pregnancy and birth.METHOD: For this constructivist grounded theory study, we recruited 22 self-identified women of color 18 years of age or older and who were between six weeks and one year postpartum. Women participated in interviews exploring their experiences, which were audiorecorded and transcribed. Data were analyzed using dimensional analysis and situational analysis methods.RESULTS: The concepts of information and power surfaced in analysis, in which providers have control over the information they share and "package" information to exert power over women's ability to participate in decision-making. An established relationship with providers and acknowledged levels of privilege or marginalization influenced how information was shared. Contextual factors included provider bias and judgment towards their patients, health care system structural issues, and the overall power dynamic between patient and provider.CONCLUSIONS: Women of color's experiences during pregnancy and birth were influenced by how they were treated by providers, particularly in how information was shared and withheld. The providers' control over information led to a power dynamic that diminished women's ability to maintain autonomy and make health care decisions for themselves and their children. This study provides insight and impetus for change in how providers share information, utilize informed consent, and provide respectful care to women of color during pregnancy and birth care.
Jump-Starting Faculty Development in Quality Improvement and Patient Safety Education: A Team-Based ApproachAbstractVan Schaik, S. M., Chang, A., Fogh, S., Haehn, M., Lyndon, A., O’Brien, B., O’Sullivan, P., Ranji, S., Rosenbluth, G., Sehgal, N., Tabas, J., & Baron, R. B. (2019). Academic Medicine : Journal of the Association of American Medical Colleges, 94(11), 1728-1732. 10.1097/ACM.0000000000002784PROBLEM: Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. Existing programs, such as the Association of American Medical Colleges Teaching for Quality (Te4Q) program, target individual faculty and thus accommodate only limited participants at a time, which is problematic for institutions that need to train many faculty to support their learners. APPROACH: The authors invited diverse stakeholders from across the University of California, San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the Te4Q program. The teams completed 5 projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS, (2) a tool kit for graduate medical education programs, (3) a module for medical school clerkship directors, (4) guidelines for faculty to integrate early learners into QI projects, and (5) a "Teach-for-UCSF" certificate program in teaching QIPS. OUTCOMES: Thirty-five faculty members participated in the initial Te4Q workshop in January 2015, and by fall 2016, all projects were implemented. These projects led to additional faculty development initiatives and a rapidly expanding number of faculty across campus with expertise in teaching QIPS. NEXT STEPS: Further collaborations between faculty focused on QIPS in care delivery and those focused on QIPS education to promote QIPS teaching have resulted from these initial projects.
Jumpstarting Faculty Development in Quality Improvement and Patient Safety Education: A Team-Based ApproachAbstractVan Schaik, S. M., Chang, A., Fogh, S., Haehn, M., Lyndon, A., O’Brien, B., O’Sullivan, P., Ranji, S., Rosenbluth, G., Sehgal, N., Tabas, J., & Baron, R. B. (2019). Academic Medicine : Journal of the Association of American Medical Colleges. 10.1097/ACM.0000000000002784PROBLEM: Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. Existing programs, such as the Association of American Medical Colleges Teaching for Quality (Te4Q) program, target individual faculty so accommodate only limited participants at a time, which is problematic for institutions that need to train many faculty to support their learners.APPROACH: The authors invited diverse stakeholders from across the University of California San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the Te4Q program. The teams completed five projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS; (2) a toolkit for graduate medical education programs; (3) a module for medical school clerkship directors; (4) guidelines for faculty to integrate early learners into QI projects; and (5) a "Teach-for-UCSF" certificate program in teaching QIPS.OUTCOMES: Thirty-five faculty members participated in the initial Te4Q workshop in January 2015, and by fall 2016, all projects were implemented. These projects led to additional faculty development initiatives and a rapidly expanding number of faculty across campus with expertise in teaching QIPS.NEXT STEPS: Further collaborations between faculty focused on QIPS in care delivery and those focused on QIPS education to promote QIPS teaching have resulted from these initial projects.
A population-based study to identify the prevalence and correlates of the dual burden of severe maternal morbidity and preterm birth in CaliforniaAbstractBackground: Prior studies have documented associations between preterm birth and severe maternal morbidity (SMM) but the prevalence and correlates of dual burden are not adequately understood, despite significant family implications. Purpose: To describe the prevalence and correlates of the dual burden of SMM and preterm birth and to understand profiles of SMM by dual burden of preterm birth. Approach: This retrospective cohort study included all California live births in 2007-2012 with gestations 20-44 weeks and linked to a birth cohort database maintained by the California Office of Statewide Health Planning and Development (n = 3,059,156). Dual burden was defined as preterm birth (<37 weeks) with severe maternal morbidity (SMM, defined by Centers for Disease Control). Predictors for dual burden were assessed using Poisson logistic regression, accounting for hospital variance. Results: Rates of preterm birth and SMM were 876 and 140 per 10,000 births, respectively. The most common indications of SMM both with and without preterm birth were blood transfusions and a combination of cardiac indications. One-quarter of women with SMM experienced preterm birth with a dual burden rate of 37 per 10,000 births. Risk of dual burden was over threefold higher with cesarean birth (primiparous primary aRR = 3.3, CI = 3.0-3.6; multiparous primary aRR = 8.1, CI = 7.2-9.1; repeat aRR = 3.9, CI = 3.5-4.3). Multiple gestation conferred a six-fold increased risk (aRR = 6.3, CI = 5.8-6.9). Women with preeclampsia superimposed on gestational hypertension (aRR = 7.3, CI = 6.8-7.9) or preexisting hypertension (aRR = 11.1, CI = 9.9-12.5) had significantly higher dual burden risk. Significant independent predictors for dual burden included smoking during pregnancy (aRR = 1.5, CI = 1.4-1.7), preexisting hypertension without preeclampsia (aRR = 3.3, CI = 3.0-3.7), preexisting diabetes (aRR = 2.6, CI = 2.3-3.0), Black race/ethnicity (aRR = 2.0, CI = 1.8-2.2), and prepregnancy body mass index <18.5 (aRR = 1.4, CI = 1.3-1.5). Conclusions: Dual burden affects 1900 California families annually. The strongest predictors of dual burden were hypertensive disorders with preeclampsia and multiparous primary cesarean.
Thematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based BirthAbstractObjective: To explore women's birth experiences to develop an understanding of their perspectives on patient safety during hospital-based birth. Design: Qualitative description using thematic analysis of interview data. Participants: Seventeen women ages 29 to 47 years. Methods: Women participated in individual or small group interviews about their birth experiences, the physical environment, interactions with clinicians, and what safety meant to them in the context of birth. An interdisciplinary group of five investigators from nursing, medicine, product design, and journalism analyzed transcripts thematically to examine how women experienced feeling safe or unsafe and identify opportunities for improvements in care. Results: Participants experienced feelings of safety on a continuum. These feelings were affected by confidence in providers, the environment and organizational factors, interpersonal interactions, and actions people took during risk moments of rapid or confusing change. Well-organized teams and sensitive interpersonal interactions that demonstrated human connection supported feelings of safety, whereas some routine aspects of care threatened feelings of safety. Conclusion: Physical and emotional safety are inextricably embedded in the patient experience, yet this connection may be overlooked in some inpatient birth settings. Clinicians should be mindful of how the birth environment and their behaviors in it can affect a woman's feelings of safety during birth. Human connection is especially important during risk moments, which represent a liminal space at the intersection of physical and emotional safety. At least one team member should focus on the provision of emotional support during rapidly changing situations to mitigate the potential for negative experiences that can result in emotional harm.
Consequences of Delayed, Unfinished, or Missed Nursing Care during Labor and BirthAbstractThe purpose of this study was to examine the concept of delayed, unfinished, or missed nursing care when patient census and acuity exceed nurse staffing resources with nurses who care for women during labor and birth. Focus groups were held during which labor nurses were asked about aspects of nursing care that may be regularly delayed, unfinished, or completely missed during labor and birth, including possible reasons and potential consequences. Seventy-one labor nurses participated in 11 focus groups in 6 hospitals. Nurses focused on support and encouragement as aspects of care that they felt are essential but often not able to be performed when the unit is busy. Nurses seemed to assume technical features of care as a "given" in the background and not always noticed unless missed. They voiced concerns about risks to maternal and fetal well-being when they were short-staffed. Potential outcomes were discussed including cesarean birth, depressed infants at birth, hemorrhage, and negative effects on patient satisfaction, successful breast-feeding, and the overall patient experience. Conclusion: When essential aspects of nursing care are delayed, unfinished, or completely missed, there are potentially negative implications for numerous patient outcomes and patient safety is at risk.