Audrey Lyndon

Faculty

Audrey Lyndon Headshot

Audrey Lyndon

FAAN PhD RNC

Vernice D. Ferguson Professor in Health Equity
Assistant Dean for Clinical Research

1 212 922 5940
Accepting PhD students

Audrey Lyndon's additional information

Dr. Lyndon is the Vernice D. Ferguson Professor in Health Equity and assistant dean for clinical research at NYU Rory Meyers College of Nursing. Her equity work is focused in two areas: maternal health equity and diversifying the nursing science and healthcare workforce. Dr. Lyndon’s maternal health work has focused on patient safety and quality in maternity and neonatal care, including improving communication and teamwork among clinicians; identifying parents’ perspectives on safety during labor, birth, and neonatal care; developing nurse-sensitive outcomes for labor and birth; and research on severe maternal morbidity and maternal mortality. Her team has conducted groundbreaking research on differences in clinicians’ and parents’ perspective on speaking up about safety concerns and developing an understanding of how women and parents conceptualize safety during childbirth and neonatal intensive care. Dr. Lyndon co-chaired the development of the CMQCC Obstetric Hemorrhage Toolkit, which became a national and international model for maternal safety bundles and collaborative quality improvement. Dr. Lyndon recently completed a study funded by the Agency for Healthcare Research and Quality examining relationships between nursing care during labor and patient outcomes. She is currently focused on understanding the experiences of Black and Latinx survivors of severe maternal morbidity to better identify their support needs, research priorities, and community-driven prevention targets for severe maternal morbidity. Dr. Lyndon’s work on diversifying the nursing science and healthcare workforce includes mentoring and sponsorship of historically excluded clinicians and scientists and efforts to build effective pathways programs for historically excluded individuals into nursing, nursing science, and clinical specialties.

PhD - University of California, San Francisco
MS - University of California, San Francisco
BA - University of California, Santa Cruz

Women's health
Health Services Research

American Academy of Nursing
American College of Obstetricians and Gynecologists (ACOG), Educational Affiliate
American Nurses Association
Association of Women’s Health Obstetric and Neonatal Nurses
International Family Nursing Association

Faculty Honors Awards

Reviewer 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)

Publications

Effect of time of birth on maternal morbidity during childbirth hospitalization in California

Lyndon, A., Lee, H. C., Gay, C., Gilbert, W. M., Gould, J. B., & Lee, K. A. (2015). American Journal of Obstetrics and Gynecology, 213(5), 705.e1-705.e11. 10.1016/j.ajog.2015.07.018
Abstract
Abstract
Objective This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization. Study Design Composite maternal morbidities were determined using International Classification of Diseases, Ninth Revision, Clinical Modification and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005 through 2007. Time of birth, day of week, and sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models. Results The odds for pelvic morbidity were lowest between 11 PM-7 AM compared to other time periods and the reference value of 7-11 AM. The odds for pelvic morbidity peaked between 11 AM-7 PM (adjusted odds ratio [AOR], 1101-1500 = 1.07; 95% confidence interval [CI], 1.06-1.09; 1501-1900 = 1.08; 95% CI, 1.06-1.10). Odds for severe morbidity were higher between 11 PM-7 AM (AOR, 2301-0300 = 1.31; 95% CI, 1.21-1.41; 0301-0700 = 1.30; 95% CI, 1.20-1.41) compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity (AOR, Saturday = 1.00; 95% CI, 0.98-1.02]; Sunday = 1.01; 95% CI, 0.99-1.03) or severe morbidity (AOR, Saturday = 1.09; 95% CI, 1.00-1.18; Sunday = 1.03; 95% CI, 0.94-1.13). Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status were also significantly associated with severe morbidity. Conclusion Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications such as hypertensive disorders, birth between 11 PM-7 AM is a significant independent risk factor for severe maternal morbidity.

Fetal Heart Monitoring Principles and Practices

Lyndon, A., & Ali, L. (Eds.). (2015). (5th eds., 1–). Association of Women’s Health, Obstetric, & Neonatal Nurses/Kendall Hunt.

Handoffs and Patient Safety: Grasping the Story and Painting a Full Picture

Birmingham, P., Buffum, M. D., Blegen, M. A., & Lyndon, A. (2015). Western Journal of Nursing Research, 37(11), 1458-1478. 10.1177/0193945914539052
Abstract
Abstract
Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. The purpose of this qualitative study was to examine medical-surgical nurses’ (n = 21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. Results indicated that offgoing nurses’ ability to grasp the story intra-shift was essential to convey the full picture during handoff. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. Future research needs to examine handoff practices and outcomes on units with good and poor practice environments.

Interpretation of Fetal Heart Monitoring

Lyndon, A., O’Brien-Abel, N., & Simpson, K. (2015). In A. Lyndon & L. Ali (Eds.), Fetal Heart Monitoring Principles and Practices (5th eds., 1–). Association of Women’s Health, Obstetric, & Neonatal Nurses/Kendall Hunt.

Postpartum care

Lyndon, A., Wisner, K., & Hung, K. J. (2015). In Management of Labor and Delivery (1–, pp. 469-509). Wiley-Blackwell. 10.1002/9781118327241.ch18
Abstract
Abstract
The overarching goal of postpartum care is to provide a safe, family-centered environment where women and providers engage in shared decision making to select treatment plans that promote physiologic and emotional adaption and family bonding. The birth process and the fourth stage of labor are dynamic and present potential risk to mother and baby. Postpartum hemorrhage remains a leading cause of maternal mortality throughout the world. Manifesting as cardiac arrest or stroke, arterial thromboembolism accounts for approximately 20% of pregnancy-associated cases of thromboembolism. Postpartum hypertension (PPHTN) is a serious and potentially underappreciated problem that may persist from pregnancy. Additional risk factors include infant characteristics such as difficult temperament, prematurity, or illness, and maternal factors such as unrealistic expectations of motherhood, low self-esteem and self-efficacy, previous depression, and a history of trauma, abuse, or perinatal loss.

Transforming Communication and Safety Culture in Intrapartum Care: A Multi-Organization Blueprint

Lyndon, A., Johnson, M. C., Bingham, D., Napolitano, P. G., Joseph, G., Maxfield, D. G., & O’Keeffe, D. F. (2015). JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 44(3), 341-349. 10.1111/1552-6909.12575
Abstract
Abstract
Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

Transforming communication and safety culture in intrapartum care: A multi-organization blueprint

Lyndon, A., Johnson, M. C., Bingham, D., Napolitano, P. G., Joseph, G., Maxfield, D. G., & O’Keeffe, D. F. (2015). Obstetrics and Gynecology, 125(5), 1049-1055. 10.1097/AOG.0000000000000793
Abstract
Abstract
Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

Contributions of Clinical Disconnections and Unresolved Conflict to Failures in Intrapartum Safety

Lyndon, A., Zlatnik, M. G., Maxfield, D. G., Lewis, A., Mcmillan, C., & Kennedy, H. P. (2014). JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 43(1), 2-12. 10.1111/1552-6909.12266
Abstract
Abstract
Objective: To explore clinician perspectives on whether they experience difficulty resolving patient-related concerns or observe problems with the performance or behavior of colleagues involved in intrapartum care. Design: Qualitative descriptive study of physician, nursing, and midwifery professional association members. Participants and Setting: Participants (N = 1932) were drawn from the membership lists of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse Midwives (ACNM), and Society for Maternal-Fetal Medicine (SMFM). Methods: Email survey with multiple choice and free text responses. Descriptive statistics and inductive thematic analysis were used to characterize the data. Results: Forty-seven percent of participants reported experiencing situations in which patients were put at risk due to failure of team members to listen or respond to a concern. Thirty-seven percent reported unresolved concerns regarding another clinician's performance. The overarching theme was clinical disconnection, which included disconnections between clinicians about patient needs and plans of care and disconnections between clinicians and administration about the support required to provide safe and appropriate clinical care. Lack of responsiveness to concerns by colleagues and administration contributed to resignation and defeatism among participants who had experienced such situations. Conclusion: Despite encouraging progress in developing cultures of safety in individual centers and systems, significant work is needed to improve collaboration and reverse historic normalization of both systemic disrespect and overt disruptive behaviors in intrapartum care.

Exploring the nature of interprofessional collaboration and family member involvement in an intensive care context

Paradis, E., Reeves, S., Leslie, M., Aboumatar, H., Chesluk, B., Clark, P., Courtenay, M., Franck, L., Lamb, G., Lyndon, A., Mesman, J., Puntillo, K., Schmitt, M., Van Soeren, M., Wachter, B., Zwarenstein, M., Gropper, M., & Kitto, S. (2014). Journal of Interprofessional Care, 28(1), 74-75. 10.3109/13561820.2013.781141
Abstract
Abstract
Little is known about the nature of interprofessional collaboration on intensive care units (ICUs), despite its recognition as a key component of patient safety and quality improvement initiatives. This comparative ethnographic study addresses this gap in knowledge and explores the different factors that influence collaborative work in the ICU. It aims to develop an empirically grounded team diagnostic tool, and associated interventions to strengthen team-based care and patient family involvement. This iterative study is comprised of three phases: a scoping review, a multi-site ethnographic study in eight ICUs over 2 years; and the development of a diagnostic tool and associated interprofessional intervention-development. This study's multi-site design and the richness and breadth of its data maximize its potential to improve clinical outcomes through an enhanced understanding of interprofessional dynamics and how patient family members in ICU settings are best included in care processes. Our research dissemination strategy, as well as the diagnostic tool and associated educational interventions developed from this study will help transfer the study's findings to other settings.

Parents' perspectives on safety in neonatal intensive care: A mixed-methods study

Lyndon, A., Jacobson, C. H., Fagan, K. M., Wisner, K., & Franck, L. S. (2014). BMJ Quality and Safety, 23(11), 902-909. 10.1136/bmjqs-2014-003009
Abstract
Abstract
Background & objectives: Little is known about how parents think about neonatal intensive care unit (NICU) safety. Due to their physiologic immaturity and small size, infants in NICUs are especially vulnerable to injury from their medical care. Campaigns are underway to integrate patients and family members into patient safety. This study aimed to describe how parents of infants in the NICU conceptualise patient safety and what kinds of concerns they have about safety. Methods: This mixed-methods study employed questionnaires, interviews and observation with parents of infant patients in an academic medical centre NICU. Measures included parent stress, family-centredness and types of safety concerns. Results: 46 parents completed questionnaires and 14 of these parents also participated in 10 interviews (including 4 couple interviews). Infants had a range of medical and surgical problems, including prematurity, congenital diaphragmatic hernia and congenital cardiac disease. Parents were positive about their infants' care and had low levels of concern about the safety of procedures. Parents reporting more stress had more concerns. We identified three overlapping domains in parents' conceptualisations of safety in the NICU, including physical, developmental and emotional safety. Parents demonstrated sophisticated understanding of how environmental, treatment and personnel factors could potentially influence their infants' developmental and emotional health. Conclusions: Parents have safety concerns that cannot be addressed solely by reducing errors in the NICU. Parent engagement strategies that respect parents as partners in safety and address how clinical treatment articulates with physical, developmental and emotional safety domains may result in safety improvements.